1990, 02-07 Permit App: 90000461 Furnace, Piping MECHANI1!L r'ERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: �' ?16 c r% I
CITY/STATE/ZIP: < y+JI`7r.L i1 { PA`CEL NUMBER:
OWNER: %"LP ( / � � PHONE NUMBER: 53Lf
MAILING ADDRESS: '�L� C /,C) } '�. e)6I1•)'Lz._ �i{ )rte Ci C -1 Zi
(Street) (City/State) (Zip)
CONTRACTOR: (L'),. t";//,1iZ"�- \ LICENSE NUMBER: 6+.ft' `,;-K
J PHONE NUMBER: 6I-//7() _OA/1, �i G
MAILING ADDRESS: 1.,0 --:)76, 7 (4,), c i t
(Street) (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 (9-y\ x 12.00 =
HEATING EQUIPMENT +100,000 BTU x 15.00 = _
GAS PIPING (1 - 4 OUTLETS) tn, 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 BTUx 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 t50 TONS - x 60.00 =
VENTILATING FANS x 10.00 =
EVAPORATIVE COOLERS_ _ _ _ _ _ x 10.00 =
12 ' OR 12 ' PTN. _OF
TYPE I. HOOD: (PER. 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 BTTJ_' _ _ x 50.00 =
UNLISTEDGAS. APPLIANCE >400,000 BTU- x100.00
USED APPLIANCE <400,000 BTU _ - x 50.00
USED APPLIANCE' >400, 000 BTU x100.00
AIRS HANDLER '<10,000 CFM x 12.00 =
AIR; HANDLER >10, 000: CFM x 15.00
SUBTOTAL` $ f6
PLUS: PROCESSING FEE ,+ $
EQUALS: TOTAL•PERMIT
NOTE: MINI UM PERMIT F IS` $35. 0 FEE `DUE, -
SIGNATURE s ,D -' 19
Spokane Coun De ment of Building and .Safety
p ty�� P o ,..
West 1303 Broadway Avenue Spokane, WA 99260 (5 9) 456-3675