1991, 02-28 Permit App 91000788 Furnacef
MECHANICAL PERMIT APPLICATION FORM
In.ormation _Worksheet
JOB STREET ADDRESS: Z / lT- 3 1 /
CITY/STATE/ZIP: ✓ 7 t-
PARCEL NUMBER:
OWNER: �w�-�`
41eIty.71 PHONE NUMBER:
MAILING ADDESS: / (Street) (City/State) (Zip)
CONTRACTOR: )44-6
CENSE NUMBER: - 1 a/ - e 1
PHONE NUMBER:
-i.
MAILING ADDRESS: 63/4/J;C,,
(Street) (City/State) (Zip)
MECHANICAL
DESCRIPTION
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000.BTU _
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (EA OUTLET)
REFRIG 1-100M BTU (NOT A/C:OR HEAT PUMP)
REFRIG 101-500M.BTU
.REFRIG 501-1,000M BTU,_
REFRIG..1,001-1,75OM,BTU__'g
REFRIG +1,750M BTU
HEAT PUMP & AIR.CONDITIONER 0 3 TONS'_
HEAT PUMP &.AIR CONDITIONER3-15'TONS.;
HEAT PUMP. & AIR CONDITIONER45-30,TONS .
HEAT -PUMP & AIR CONDITIONERi30-50 TONS
•
HEAT PUMP & AIR CONDITIONER +5.0..;,.TONS ,, ;
VENTILATING FANS
EVAPORATIVE COOLERS'
TYPE I 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_ _ _
UNLISTED 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
WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS [UNIT
= AMOUNT
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x '- . 0 0 =
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
x 60.00 =
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 =
NOTE: MINIMUM PERMIT FEE IS $35.00
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
SIGNATURE
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675