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1993, 01-05 Permit App: 93000022 Gas Log, PipingC f{) OG 1(e. 6 JOB STREET ADDRESS: 1 1G CITY/STATE/ZIP. , • P° OWNER: V rrC MECHANICAL PERMIT APPLICATION FORM Information Worksheet . &LJdJ5k q Z7 75(co lAzt ‘161 Co PARCEL NUMBER: 1.)) CU.S PHONE NUMBER: 9-2- - 73-2(o MAILING ADDRESS (Street) (City/State) gip) CONTRACTOR: ro C iff);7-1,i CF;,e LICENSE NUMBER: 1(.0 (I'l 73 b PHONE NUMBER: MAILING ADDRESS: DESCRIPTION ()3; (Street) <-- (City/State) MECHANICAL Vv'OHKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE S`r;•TTEMS) WOODSTOVE/INSE.RT'±: . . .. ... . . ...... .................. . ..... ... GAS WATER HEATER :GAS EQUIPMENT„f4(100,000 BTU INCLUDE GAS EQUIPMENT +100,000 BTU DUCTWORK) rlrlNG (A OUTL i) BOILER/REFRIG 1-100M BTU . - biLr.R/R;:FRIGA 011.500M -BTU BOILER/REFRIG 501-1,000M BTU Boi4-E4REFRja:1;ppp.-I:i:v;T.-pm. sr._ ,EdI.LER/RE.FRIG+1,750M BTU . HEAT PUMP & AIR CONDITIONER 3-15 TONS - -• •r -FET. HEAT PUMP &AIR CONDITIONER 30-50 TONS - 1-irEAT PUivfEe.AIRtoNDITIONr;-E' 56TONIS VENTILATING FANS :i'IAPCATVE COOLES. , TYPE 1 HOOD (PER 12' OR 12' PTN. OF HOOD) CLOTHES DRYER GAS LOG MISCELLANEOUS,(NOT COVERED El UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED.GAS:ApPLIANC,E.00;000 sTru USED APPLIANCE <4C•0,000 BTU USED APFLIANCE >.00,G00 3TU AIR HANDLER <10,000 CFM A:R HANDLER >10,000 CF.. . • NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE C79 7 C (ZiP) NUMBER OF UMTS X EACH UNIT = AMOUNT .Y. 10.0 = x25.00 = x10.00 = IIIIIIIIIIIII x 12.00 = x 15.00 = x1.00 = x 12.00 = x20,00 =.. x23.00 = x 35.00 = x60.00 = x 12.00 =. x 20.00 = x 25.00 = x35,00 = x60,00 . x 1 o.00 = xi ma = 1 . IIIIIIIIIIII - • . • IIIIIIIIIIIII 11111111111111111111 11111111111111111111 x 50.00 = x 10.00 = x10,00 = x10.00 = x10,00 = 111111111111=1 ) D , OC) IIMIIIIIIIIIII x10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = SUBTOTAL S f I -OD PLUS: PROCESSING FEE + $ 25,00 EQUALS: TOTAL PERMIT FEE DUE =$ 36,00 Spokane County Division of Buildings