1992, 03-06 Permit App: 92001304 Propane Tank, PipingJOB STREET ADDRESS:
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
2 9/ S Bar/ler
CITY/STATE/ZIP: Gveen ,OcrPARCEL NUMBER:
OWNER: Atc /c /rijOi7 PHONE NUMBER: 9296c/g3
MAILING ADDRESS: P
jf ytreet)/ (City/State) (Zip)
CONTRACTOR: P7/77S°F'�CJrls.f iC6(!4�' LICENSE NUMBER: /Pin -en -i'jD/s'.t'
/ / l PHONE NUMBER: 5.31-6/72 Z
MAILING ADDRESS: F 33 2' 4 / /pen 4,";Azi,e G/a 9'�z07
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOOOSTOVE/INSERT::;;.': ----
GAS WATER HEATER
'GAS EQUIPMENT <100,000 BTU
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS.PIPING (EA OUTLET).
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 101500M BTU
BOILER/REFRIG 501-1,000M BTU
'BOILER/REFRIG=1,0001-1,750M 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 TONS"':'
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT -PUMP & AIR CONDITIONER +50 TONS"
VENTILATING FANS
EVAPORATIVE 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>10,000'COM
500 W/L p / r'm c
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
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 =
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 =
/r Ct)
?,_.s.---e-,c)
SUBTOTAL
$ 3,o(Z)
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $.3.°C-3.
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675