1996, 01-02 Permit App: 96000017 Furnace, Piping MECHANICAL PERMIT APPLICATION FORM
Ir.f orma tact. Wcrksheeti•, A (
JOB STREET ADDRESS: 17 / r , d' A r�`� ' ' l7
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CITY/STATE/ZIP:`9: wrc q9 L'I '� PARCEL NUMBER:
OWNER: ,),4sJ Pry in 4-� PHONE NUMBER: y (v _S-A) 7 7
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: S i S LICENSE NUMBER: A ,(' -5,Z 3.7,2 Ai
PHONE NUMBER: 4/ yc('
MAILING ADDRESS: 45-6 6; E c 6,,c S Lc., ���1 �i,7-i e Ct,i4 �' zc 7
(Street) (City/State) (Zip)
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MECHANICAL WORRST/FEE SCHEDULE
NUDESCRIPTION I OF UNITSUNI xUNIT` I = AMOUNT I
DUCTWORK SYST x$10. 00 =
WOODSTOVE/INSERT x 25. 00 =
GAS WATER HEATER x 10. 00 =
HATING EQUIP=T <100, 000 BTU x 12. 00 = / ,. U
SEATING EQUIPMENT +100, 000 BTU x1;4;
GAS PIPING (1 - 4 OUTLETS) _ _ x -= / C d
GAS PIING (5 OR MORE. EACH: ) x 1. 00 =
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12. 00 =
REFRIG 101-500M BTU x 20. 00 =
REFRIG 501-1, 000M BTU x 25. 00 =
REFRIG 1, 001-1, 750M BTU x 35. 00 =
REFRIG +1, 750M BTU x 60. 00 =
HEAT PUMP & AIR CONDITIONER 0-3 TONS _ _ x 12 . 00 =
HEAT PUMP & AIR CONDITIONER 3-15 TONS _ x 20. 00 =
HEAT PUMP & AIR CONDITIONER 15-30 TONS _ x 25 . 00 =
HEAT PUMP & AIR CONDITIONER 30-50 TONS _ x 35. 00 =
HEAT PUMP & AIR CONDITIONER +50 TONS _ _ x 60. 00 =
VENTILATING FANS x 10. 00 =
EVAPORATIVE COOLERS x 10. 00 =
TYPE I HOOD (PER 12 ' OR 12 ' PMN. OF HOOD) x 30. 00 =
TYPE II HOOD x 10. 00 =
CLOTHES DRYER x 10. 00 =
RANGE x 10. 00 =
GAS LOG x 10. 00 =
MISCELLANEOUS (NOT COVERED ELSEWHERE)_ x 10. 00 =
UNLISTED GAS APPLIANCE <400, 000 BTU _ x 50. 00 =
UNLISTED GAS APPLIANCE >400, 000 BTU_ _ _ x100. 00 =
USED APPLIANCE <400, 000 BTU x 50. 00 =
USED APPLIANCE >400, 000 BTU x100. 00 =
AIR HANDLER <10, 000 CFM x 12 . 00 =
AIR HANDLER >10, 000 CFM x 15. 00 =
SUBTOTAL $ c�=
�• �� MAAStC- 1-lj/Kp- -7s PLUS: PROCESSING FEE + $ 25 . 00
EQUALS: TOTAL PERMITT oo
NOTE: MINIMIIM PERMIT FEE IS $35. 00 FEE DUE = $
SIGNATURE
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675