1991, 06-21 Permit App: 91003532 Furnace, PipingMECHANICAL PERMIT APPLICATION FORM
JOB STREET ADDRESS:. f- / /// / ('p formation Worksheet
CITY/STATE/ZIP: Lf$fG4�/P. /�/q, /xj 44 PARCEL NUMBER:
OWNER: aq,q A PHONE NUMBER:
MAILING ADDRESS: �402LC/
(Street) SENUtate)MBE 067k P,esiyi SP
CONTRACTOR: ���I _Tile LICENSE NUMBER:_,`p
PHONE NUMBER: 7 D a2 -i x.33
MAILING ADDRESS:�9�zji a� r Z /�
(Street) (City tate) (7p)
MECHANICAL WORKSHEET/FEE SCHEDULE
TYPE I HOOD (PER 12' OR 12' PTN. OF
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE>400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU,
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
NOTE: MINIMUM PE FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
XEACH
UNIT
=AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
X100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
a..�
/
SUBTOTAL
$
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ y0 -'C%
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675