1990, 03-30 Permit App: 9000119 Furnace MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: V 3
t A l --1�a'�''
CITY/STATE/ZIP: q7Q11., PARCEL NUMBER:
OWNER: V1 e PHONE NUMBER: 9gQ -�1�'
MAILING ADDRESS T`�1.1: •-��' l'. )
�-� � (Street) (City/State) (Zip)
CONTRACTOR: '" rc-:G�r1 � ,i j LICENSE NUMBER: (Er ‘W77RIA C tl ir c c,
PHONE NUMBER: R 4 --- ki,,S a i
MAILING ADDRESS: XE7 n `) - _ -7`rk..- .G1) ,`----*0., st:*\ cY.
(Street) Y (City/State) (Zip)
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 = la °C'
HEATING EQUIPMENT +100,000 BTU x 15.00 =
GAS PIPING (1 - 4 OUTLETS) x 4. 00 =
GAS PIVING (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 =
t`- SUBTOTAL $ a oc)
____.. ..\z,V,...r.,-;,,v,,,1/4.-%z"K' 3 PLUS: PROCESSING FEE + $ 25. 00
EQUALS: TOTAL PERMIT
NOTE: MINIMUM PERMIT FEE IS $35.00 I FEE DUE = $ 7
SIGNATURE
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675