1991, 08-29 Permit App: 91005431 Gas FurnaceMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: /d/'O
CITY/STA IP J j ]T/1/j/F _11- 67 1'Z / 2- PARCEL NUMBER:
OWNER - ., ) / 1 - PHONE NUMBER: V -C:5 T 7 j
MAILING ADDRESS:// / d i 6 7 .- / -2
(City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
g 0. --e5 Olo
6
(Street)
DESCRIPTION
(Street)
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER
GAS £QUI MENT OO OOO TU (INCLUDES:
GAS EQUIPMENT +100,000 BTU DUCTWOR
K)
GAS>PIPING (EA_OUTLTj:..;:.:;:.
BOILER/REFRIG 1-100M BTU
'iSOMENREFRial0i500M
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,000W5
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AI.R CONDITIONER'15-30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & AIR CON:.DITIONER +50 TONS
.::...
VENTILATING FANS
EVAPORATIVE COO LERS
TYPE 1 HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000°CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
Spokane County Division of Buildings
West 13(13 Rrnariwav Avr n11P Snnkana WA QQ9nn /Lnc»