1991, 10-10 Permit App 91006738 FurnaceMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: CC; 7 7/i1> ✓3U20 fti�f/s� �A l/
CITY/STATE/ZIP:4 7i. PARCEL NUMBER: / `C - - b
OWNER: /C /f/5S _ PHONE NUMBER:
77 . 7
(Street) (City/State)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
MAILING ADDRESS:
(Zip)
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOOOSTOVE/INSERT
GAS WATER HEATER
GAS EQUIPMENT <100,000 BTU (INCLUDES
•
..........
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS PIPING (EA
BOILER/REFRIG 1-100M BTU
.......................... .
BOILER/REF'RI '1-500M BT'
BOILER/REFRIG 501-1,000M BTU
................................... .
BOILER/REFRIG 1,0001-1,750M:Bi`!>s>`>>'`':»'<::...:
BOILER/REFRIG +1,750M BTU
HEAT PUMP AIR CONDITIONER 0, S'iONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
T PUMP AIR C NDITIONE ...15 '!'t `v }
HEAT PUMP & AIR CONDITIONER 30-50 TONS
NEAT PUM AIR C NDITI+C NER + 0 TONS ;; > ::• •
VENTILATING FANS
...........................
EVAPOR E 000L RS•
TYPE I HOOD (PER 12' OR 12'PTN.OFHOOD)
TYPE II HOOD
CLOTHES DRYER
..................
RANGE
GAS LOG
........................... .
MISCELLANEOUS;(NO ERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
...........................................................
ULINSTEDGAS
USED APPLIANCE <400,000 BTU
USED APPLIANCE'>400i:S''I::;::
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000'EFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
e‘zza-/
(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 =
x12.00 =
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 =
/1 0 "
,./
�,(11
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675