1993, 06-21 Permit App 93004876 Wtr Htr, FurnaceUAL, ra-74.3 "i 5.14.1"11V11 rut i i
Ir.,formatior. Warksheet
JOB STREET ADDRESS: /32/2 /
S2-/ . Dt
CITY/STATE/ZIP: f (t/Clg9,2-QPARCEL NUMBER:
OWNER:,( / Ate; PHONE NUMBER:
MAILING ADDRESS: /-/2 ( /
(Street)
CONTRACTOR:
MAILING ADDRESS:
DESCRIPTION
DUCTWORK SYSTEM
LICENSE
PHONE
WOODSTOVE/INSERT
GAS WATER HATER
HEATING EQUIPMaNT <100,000 ETU
HEATING EQUIPMENT +10 0 , 0 0 0 ETU
GAS PIPING (1--4'OUTLETS)
GAS PIING (5 OR MORE. EACH : )
REFRIG 1-10 0M BTU (NOT A/C OR HEAT PUMP)
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
0-3 TONS _
3-15 TONS _
15-30 TONS _
30-50 TONS _
+50 TONS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12'
TYPE II HOOD
CLOTHES DRYER
RANGE
OR 12' PTN. OF HJO D)
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)
UNLISTED GAS APPLIANCE <400,000 ETU _
UNLISTED GAS APPLIANCE >400,000 BTU_ _
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000.BTU
A_IR HANDLER < 10 , 0,00 CFM
AIR HANDLER >10,000 CFM
NOTE:
SIGNATURE
6 3 _) n -)
(Street) :
(City/State) (Zip)
NUMBER: SE- / 3 7,-)2t77-
NUMBER : Vg ca S7o5
if (n
ity/State) (Zip)
milincornimmirieszmilmiiiffilimerzmwmparmowassainigiemirimila
MECFaNTCAL WOR_YS EET/FEE SCHEDULE
NUMEER X EACH j
OF UNITS UNIT I = AMOUNT
r
x$10.00 =I
x 25.00 =
x 10.00 =
x 12.00 =
x
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 =
Y 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
PLUS: PROCESSING FEE
2 99 2
/0(00
/• 00
* $ 25.00
NIMUH PERMIT PEE IS $35.00
1170 06 ppo e CountyDepartment of Buildingand Safety •
West .303 BroadwaAvenue Spokane, WA 99260 (509) 456-3675
EQUALS: TOTAL PERMIT
FEE DUE
1'