1991, 08-22 Permit App: 91005200 Furnace, Piping -/I: 1.4.3
MECHANICAL PERMIT APPLICATION FORM flc"
Information Worksheet
JOB
JOB STREET ADDRESS: 776 0 -� 9-6:6-
4
CITY/STATE/ZIP: 4ZD�i � /c� ‘D-6
Sq PARCEL NUMBER: S-( �- ,,'Z d a
OWNER: R t (inoJ>4- \ 1-t99, � PHONE NUMBER: I q. ,93----10
MAILING ADDRESS: Ql $O __ v( ( lOg_ tii,r2A0 i 719cL 990-c
(Street) /(City/State) (Zip)
CONTRACTOR:01.) � /812(..41)-6-A___, LICENSE NUMBER: Se-/4g oL 3 7 /vT
PHONE NUMBER: lag- // 7e X.3'-/7'
MAILING ADDRESS: A/ 3 70 7 ue, (..62Q9 7
(Street) (City/State) (Zip)
, , t Y .
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM x$10. 00 =
WOODSTOVE/INSERT x 25. 00 =
GAS WATER HEATER x 10. 00 =
HEATING EQUIPMENT <100, 000 BTU / x 12.00 = /, OD
HEATING EQUIPMENT +100, 000 BTU x 1
GAS PIPING (1 - 4 OUTLETS) / x .�6 e-= / ' O c)
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 ' PTN. OF HOOD) _ x 50. 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 $ / , aD
PLUS: PROCESSING FEE + $ 25. 00
EQUALS: TOTAL PERMIT a
NOTE: MI IM'' k - .0f, FEE IS $ 5. 0 0 FEE DUE = $ �o
SIGNATUR ,i' A 0 ,1111"II io
Spoka - Cody Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675