1991, 12-04 Permit App: 91008372 Furnace, Piping MECHANICAL PERMItAPPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: 9
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: 0C.JA 2w PHONE NUMBER: c7.24/-
MAILING
24-MAILING ADDRESS: 7 5:;74/ 1,(g
(Street) (City/State) (Zip)
CONTRACTOR: u/1-IF 1'97 /tizc 17.4L4.; LICENSE NUMBER: Cf0/77Zc .7.2,%?()
PHONE NUMBER: y'-.? ( - -,s I st
MAILING ADDRESS: // /o z vtl .20
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
x 25.00 =
GAS WATER HEATER x 10.00 =
GAS EQUIPMENT<1pt000 ITU{INCLUDES :::;::..:. :-- t x 12.00
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING (EA OUTLET] 1 x 1.00 =
BOILER/REFRIG 1-100M BTU x 12.00 =
x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILERIREFRIG 1.,0001_:1,750M BTU'; x 35.00 =
BOILER/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 CONDITION.ER 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 =
TYPEII HOOD x 10.00 =
CLOTHES DRYER x 10.00 =
RANGE x 10.00 =
GAS LOG x 10.00 =
ISGELL.+IEOUS OTCOVERED ELSEWHERE 3 x1 o.00
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINS' gaGAS1 PPUANCEi*O0, 3TU :>>:gag <= x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
: .5AI 'f��►NOE��::))�))O( >:. >:<>�:><:>:> <:><:>»»»>>:><::><<>>:>< x100.00
� ) =
AIR HANDLER<10,000 CFM x 12.00 =
AC : fANDt =
.; :.;;:;;;:;;:>::;;;;:�1�;:.:.;'tf�� 1Q:�.;:.;:.:�:.;.;;:->.;;;;:.;;;;:;:.:_:.;:.;:.;;:.::;;:::;;:;:.>:.;:::.;:.;:.:.;:.>:.;;;>;:::.;:.: x 15.00
SUBTOTAL $
PLUS: PROCESSING FEE +$ 25.00
NOTE MINIMUM PERMIT FEE IS$35.00 EQUALS:TOTAL PERMIT
FEE DUE =$
SIGNATOR --a
Y 44->e°//
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675