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1991, 08-08 Permit App: 91004862 Gas Piping
MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: Hfl S2 -1--A CITY/STATE/ZIP: Van) ANIN, 720k, PARCEL NUMBER: OWNER: A. EQQ PHONE NUMBER: °[? (, 51 MAILING ADDRESS: C., - 1S2-2--\ (ANA CriT (Street) (Cit /State) (Zip) CONTRACTOR: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTR1C/DUCTWORK (SEPARATE SYSTEMS) WOODSTOVEJINSERTGAS WATER HEATER GAS EQUIPMENT.'.:510p,o0oi.f73TV(INpLU,DEs-,::-, GAS EQUIPMENT +100,000 BTU DUCTWORK) GAS PIPING (EA OUTLET) BOILER/REFRIG 1-100M BTU E3Q)1xiit9F91q1pj5qpm!!toltgag:- BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG 1,0001-1,750M BTU BOILER/REFRIG +1,750M BTU HEATPOMP,‘&AIR:CONDITIONER.9=1-ToNs HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT PUMP & AIR CONDITIONER 15-30 TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS HEAtPUMP.-&-A1R CONDITION ER -*50 TONS . . VENTILATING FANS EVAPORATIVE COOLERSTYPE 1 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 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x10.00 = x 25.00 = x10.00 = 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 = x10.00 = x10.00 = x 50.00 = x10.00 = x10.00 = x10.00 = x10.00 = x10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675