1994, 04-06 Permit App 94002839 Furnace, Wtr HtrJOB STREET ADDRESS:
CITY/STATE/ZIP:.5pe
OWNER: C-_,P02 r
MECHANICAL PERiviri APPLICATION FORM
Information Worksheet
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q� a8`39
3o57
%y0/,9 PARCEL NUMBER:
PHONE NUMBER: -- 9
MAILING ADDRESS: •
(Street) ' _(City/State) (Zip)
CONTRACTOR: t) fry-r-n Ii...P-itt- ,i LICENSE NUMBER: NI, Pco HA 07 6 41
-�-- 1 PHONE NUMBER:. 3.1- 4/ 75
MAILING ADDRESS: F, .7 / 0 3 l ��� XJJ_-A,r,__ /9%C z,g,L,L
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
•
BOILER/REFRIG 1-100M BTU
'.I.E .::.::.EF
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
GEA,T PULP & AER CONDITEC ER t-3 ONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
: .....:<..
HEAT PUMP & AiP.COND TIONEl 15-30 TOWS.
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PU P & AIR COi D�T1ONER +50 TONS
VENTILATING FANS
iATIVE::„..O.LEA,:..`<»<<
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
....................................................................................................................
CLOTHES DRYER
GAS LOG
" i GELLANEO S'(NO G• :•.g6ED EL SEWNERI
UNLISTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
......................................................... .
AIR HANDLER <10,000 CFM
;HA1��irER lf�l
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
./z„, /4g--611-
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00 =
x10.00 =
x12.00 =
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 =
x25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.b0 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
/
J0,00
/5 on
�, (➢c5
m�
•
SUBTOTAL
$ , 5 h/, o 0
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
�/
=$ "l 0- OG
Spokane County Division of Buildings
West 1303 I Avenue Spokane, WA 99260 (509) 456-3675