1990, 09-18 Permit App 90004685 Furnace MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: `D i/1-� Ex.D /�CIVsk ) -- - QciXta
CITY/STATE/ZIP: C-pQNr,, PARCEL NUMBER: D ��
OWNER: / y rruv Vt PHONE NUMBER: 04I \
MAILING ADDRESS: .-
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(Street (City/State) (Zip)
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CONTRACTOR: ( Q 51 -21�- LICENSE NUMBER: c
PHONE NUMBER: P� _ c. Y c(7
MAILING ADDRESS: v-.Piv \ -- ''
(Street) /J (City/State) (Zip)
MECHANICAL WORKSHEE1'/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 =
HEATING EQUIPMENT +100, 000 BTU x 15. 00 =
GAS PIPING (EA OUTLET) 1 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 12.0C =
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 =
SUBTOTAL $
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT^
NOTE: M NI UM PERMIT FEE S $35.00 FEE DUE = $
SIGNATURE Kg/
VC Spokane County Department of Building_ and Safety
est 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675