1993, 06-24 Permit App 93005058 FurnaceMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: / t9G? 3 %,
CITY/STATE/ZIP: , �,,�/ PARCEL NUMBER:
OWNER: /%�ri1 //�✓t�`�/ii� ,
MAILING ADDRESS:
CONTRACTOR:
PHONE NUMBER:
451
q3 -505-
(Street)
(City/State) (Zip)
LICENSE NUMBER:
O PHONE NUMBER:^„
MAILING ADDRESS:C-2 /,33, , 3 L�,(��
(Street) (CityiState)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
W -
OODST01/ IN
GAS WATER HEATER;::.::...............................................................
GAS: EQUIPMENT <100,000 BTU (IINCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS ;PIPING EA OUTL
BOILER/REFRIG 1-100M BTU
B.O.ILER/REI=:RIG:1:0.1-500M>BT
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,0001 1,750M BTU`::::;;:.:; >'>_ <
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AI:R CONDITIONER 0 3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 15 30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & AIR CONDITIONER +5•
0
VENTILATING FANS
............................
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 >400000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER>10,000.:CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATUR
99 ?/g
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
j
x 12.00 =
f, a
x 15.00 =
/
x 1.00 =
/, OG
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 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
S /3,Go
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=S -3P,aG
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675