1991, 08-26 Permit App 91005316 Furnace, Log, ACMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: L-. • 1 w503 - 3 .0)RDl v/��
CITY/STATE/ZIP: , POkA�& tviq. 9 2 ((o PARCEL NUMBER: {
OWNER:J-d14/\% �,�,( o O V5 PHONE NUMBER: G /, L' pC y
MAILING ADDRESS: E. ! `-150.3 t Ql- JA7 lj. Pv. L,Uf . 216,
(Street) (City/State)
CONTRACTOR: Q) A L L T y HTT . LICENSE NUMBER:
PHONE NUMBER:
(Zip)
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/1NSER7
.............:.........:..::::..:.:......:..::.........
GAS WATER HEATER
.................
GAS: EQUIPMENT <10(,000 BTU' (INCLU......
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS;PIPING EA OUTL
BOILER/REFRIG 1-100M BTU
BOI ERIREFR G 1:0,1 00M BT ;.;
BOILER/REFRIG 501-1,000M BTU
BO(L ER/REFRIG 1 001 1 750M BTU»
BOILER/REFRIG +1,750M BTU
HEAT PUMP &: AIR CONDITIONER 0 3 TONS:;::.:;;
HEAT PUMP & AIR CONDITIONER 3-15 TONS
...... ............
HEAT. PUMP & AIR CONDITIONER 15-30 T.ONS`::>' :: >: >
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP &. AIR CONDITIONER:+50 TONS >> `'
VENTILATING FANS
APORATIVE 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
ULINSTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED.: APPLIANCE : 400,000 .BTU
AIR HANDLER <10,000 CFM
AIR HANDLER>10000:CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATUR
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
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 =
x 25.00 =
x 35.00 =
x60.00 =
/
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
1
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
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