1991, 02-05 Permit App: 91000381 Dryer, PipingMECHANICAL PERMIT APPUCATION FORM
Information Worksheet
JOA STREET AbDRESS t. �g Z -Z •
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: PHONE NUMBER:
MAILING ADDRESS:
(Street) (C
CONTRACTOR: x-14-SL,LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRES
;(Street)
/State) (Zip)
b4 -14--t c o3 Z..
s ( )-0
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
DESCRIPTION
ca
(Zip) cf X04 ,
=AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PIPING (5 OR MORE. EACH:)
REFRIG 1-100M 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
AIR CONDITIONER 0-3 TONS
AIR CONDITION 3-15 TONS _
AIR CONDITION '15-30 TONS
AIR CONDITIONER 30-50 ,TONS
AIR CONDITIONER +50 TONS _
FANS
IERS._
12'
ER
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT .PUMP &
VENNI[A'ING
EVAPQ
TYPE I RSfXoD"
TYPE IU,_HOOB
CLOTHES DRY
RANGE
GAS LOG
:OF SOW)
MISCELLANEOUS (NOT COVERED.:ELSEWHERE)_ _
UNLISTED . GAS APPLIANCE ‹4004.000 000 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 4.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 24.00 ;'.
x 25.00 =.�
Ax 35.00 seg
x' '60.00 _.
x 10.00 ;
X, 10.00'
.;. 'X ' SO. 00 wr
X ..,£x:.#10 '=:.
x ;_10.00
x ;:10.00 =
x 10.00 =
x 10.00 =
x 30.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
NOTE: MI MUM ERM FEE IS $35.00
SIGNATURE
Snokane County npnirtment of Building and Safety
SUBTOTAL~
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE