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1994, 08-01 Permit App 94007228 Furnace, ACJOB STREET ADDRESS: f CITY/STATE/ZIP: OWNER: , ). MAILING ADDRESS: MECHANICAL PERMIT APPLICATION FORM kJ 7 2 2 65 -InhorhtitiGn Worksheet OQCt-t A �� A-DD e -f 9`t PARCEL NUMBER: 645-7a 4 65 PHONE NUMBER: 7,4 - lJ � -5 (Street) CONTRACTOR:A) (city/State) 1 n (gyp) LICENSE NUMBER: A/(i/� r() A ('j 7 (, 2--/ / PHONE NUMBER: MAILING ADDRESS: S / 0 ? T -v'- - t (Street) DESCRIPTION (City/State)/ MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODSTOVEI' . S .....:::.......:.:..:::.;..:.......... GAS WATER HEATER GAS,EQUIPMENT <100,000 BTU /(INC(UDES GAS EQUIPMENT +100,000 BTU DUCTWORK) GAS::PIPING: (EA BOILER/REFRIG 1-100M BTU S01LEA1RFP.4gi: • 1` 5Ct1M TU: . BOILER/REFRIG 501-1,000M BTU BOILERIREFRtG;1 750M,'BT BOILER/REFRIG +1,000t-1750M BTU :HEAT;PUMP :AIR CONDITIONER HEAT PUMP & AIR CONDITIONER 3-15 TONS .HEATPUMP &AIR CONDITIONER.15 .30.TONS ;: HEAT PUMP & AIR CONDITIONER 30-50 TONS ;HEATP.UMP &`AIRCONDITIONER` 50:TONS:! VENTILATING FANS EVAPORATIVE•COOLERS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPE II HOOD ::.. :..,. . CLOTHES DRYER :RANGE:::' GAS LOG MISCaLLANEOUS (NOTCOVERED'ELSEWHERI UNLISTED GAS APPLIANCE <400,000 BTU :ULINSTED GAS: APPLIANCE>400,000BTU USED APPLIANCE <400.000 BTU USED APPLIANCEa400;000: BTU AIR HANDLER <10,000 CFM .AIR 'HAND.LER>1.0 000'CF NOTE: MINIMUM PERMIT FEE IS $35.00 (zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x25.00 = x 10.00 = j x 12.00 = JO,o0 x 15.00 = x 1.00 = x 12.00 = x20.00 = x 25.00 = x 35.00 = x 60.00 = x12.00 = x20.00 = x25.00 = x35.00 = x60.00 = x 10.00 = x 10.00 = x50.00 = x 10.00 =• x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 5a.c00 = x100.00 = x 50.00 = x100.00 = / /o9, 00 x 12.00 = x 15.00 = SUBTOTAL $ n O PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $,,(/9, PO SIGNATURE e e Spokane County Division of Buildings West 131 'gray Avenue Spokane, WA 99260 (509) 456-3675