1990, 05-30 Permit App: 90002398 Furnace MECHANICAL PERMIT APPLICATION FORM -IA 2 u
Information Worksheet
JOB STREET ADDRESS: 6 1 I u .i 1 \ '4 A i -
CITY/STATE/ZIP: •.;r 'j et,k)(r, PARCEL NUMBER: '�S J`- ``f - 0/ a
OWNER: R t7l, 0\(CI V)e;.,---t PHONE NUMBER: 9 a rc - 8 4
MAILING ADDRESS: ..' elr,Il*...1 JxzitilN __.-
(Street) i , (City/State) (Zip)
CONTRACTOR: l 'N '� N ►4 l k LICENSE NUMBER:G. I,NI C._ f l cc_
PHONE NUMBER: ;)"2, ; --- 2
MAILING ADDRESS: 1 i c) a,.2, -- : i '‘` A..;.E . �� C (A t ci9 a)3
(Street) (City/State (Zip)
( P)
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 = / -rata
HEATING EQUIPMENT +100, 000 BTU x 15. 00 =
GAS PIPING (1 - 4 OUTLETS) x 4. 00 =
GAS PI?ING (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 1,IN. OF HOOD) A ✓V 5n• V V 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 $ Ig_Ot)
PLUS: PROCESSING FEE + $ 25. 00
EQUALS: TOTAL PERMIT
NOTE: MNI UM (P • I i FEE IS 9FEE DUE = $ 37.06
SIGNATURE ',I- 1 %1p 1-- -
Spokane C I , ty [Apartment of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675