1991, 02-26 Permit App: 91000719 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM 43 - J a
Information Worksheet
JOB STREET ADDRESS: / / O / 1 L 6, 4'-- 02C-6/3 - .Jt'
02,3
CITY/STATE/ZIP: 5.9--'4 C - 4 PARCEL NUMBER: /7/%5 /.,5:% :i
OWNER: r3 E. 714 fiL , ,ti'! PHONE NUMBER: S Z L 1-1 J 3
MAILING ADDRESS: 7Y-26 6
(Street) (City/State) (Zip)
CONTRACTOR: BANNER FURNACE F FUEL LICENSE NUMBER: BANNEFF378NT
CONTACT: RUSS LUNDE PHONE NUMBER: 535-1711
MAILING ADDRESS: P.O. BOX 4346 SPOKANE, WASHINGTON 99202
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER I X EACH
DESCRIPTION 1 OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM X$10.00 =
WOODSTOVE/INSERT x 25.00 =
GAS WATER HEATER x 10.00 = /0. 0 o
HEATING EQUIPMENT <100,000 BTU x 12.00 = / 2_ 00
HEATING EQUIPMENT +100;000 BTU x 15.00 =
GAS PIPING (1 - 4 OUTLETS) __ X 4.00 = 41 .- cl0
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 TONSx 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 =
SUBTOTAL $ ,Z 0
PLUS: PROCESSING FEE + $ 25. 00
EQUALS: TOTAL PERMIT
NOTE: MINIMU PERMIT FEE I $35.Oo FEE DUE = $ S ( , 00
SIGNATURE 1, 4/4 e
S a ane County Dep ment of Building and Safety
West 1 03 Broadway Avenue Spokane, WA 99260 (509) 456-3675