HomeMy WebLinkAbout1992, 11-18 Permit App: 92010155 Gas Log, PipingJOB STREET ADDRESS:
MECHANICAL PERMIT APPLICATION FORM
Infognatiot Worksheet
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CITY/STATE/ZIP: Croltpii.
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l 9-.19 PARCEL NUMBER: /
OWNER: B0,0 G o l&L) PHONE NUMBER: 0 p�''7 f )'k
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MAILING ADDRESS: SAt
(Street) (City/State)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Zip)
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
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GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
..............
..................
BOILER/REFRIG +1,750M BTU
31'�i'M+%if:yV!�:ttif �:Y►':r:�:1:�t f.1%:YF(�?yi'li'f1i?C17i!4Ki'L"d
HEAT PUMP & AIR CONDITIONER 3-15 TONS
H:A`f'(lVlf'>11t+1iT)I.• I`>`IT•`.
HEAT PUMP & AIR CONDITIONER 30-50 TONS
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VENTILATING FANS
................
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
MISEELL4NEOU$ �NO'1``GOVE1 ED ELS;E`W
UNLISTED GAS APPLIANCE <400,000 BTU
CILINS EI AS<APPLIAN 4t ( 0(1 S &)
USED APPLIANCE <400,000 BTU
I1:S I] AP LiAN.G_ tt1t F{l Q
AIR HANDLER <10,000 CFM
AIRHANbf 10000 FM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE �Ju.2IC
(Zip)
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 =
/
%
/
/6'6')
SUBTOTAL
$ //•('t
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ 31' of)
/ Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675