1991, 03-20 Permit App 91001214 FurnaceMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: - 77 -3
CITY/STATE/ZIP:
%7o.i
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OWNER: 1,�.�f �'�-tip c ?�' ��<L��✓
MAILING ADDRESS: /, < m , "rx / q/ '/'I
(Street)
SMITH HEATING
CONTRACTOR:
E. tu2?iOrsn
SPOKANE, WA 99207
(509) 328-4431
iA,-
PARCEL NUMBER:
PHONE NUMBER://- 9 7 5 v
91/'/ r /46Y9
(City/State) (Zip)
LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS: WAYNESH258NJ
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT
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
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1, 001-1', 750M BTU
REFRIG +1,750M BTU
HEAT'PUMP.&-AIR`CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR 'CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
VENTILATING FANS
HEAT PUMP) _
EVAPORATIVE COOLERS
0-3 TONS _ _
3-15 TONS _
15-30 TONS _
30-50 TONS
+50 TONS
TYPE I HOOD (PER 12' OR 12'
TYPE II HOOD
PTN. OF 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
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
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 =
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 =
= AMOUNT
-0 a/
NOTE:
SIGNATURE
MINIMUM PERMIT FEE IS $35.00
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
SUBTOTAL
PLUS: PROCESSING FEE
$ /5
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= 7i�