Loading...
1991, 11-18 Permit App: 91007960 Gas Log, PipingX11-Vic2,0 MECHANICAL PEIIIIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: L2 3e 1 S R0 y, .. :,47,z CITY/STATE/ZIP: Vie' ' (e - 9' 9 2 PARCEL NUMBER: OWNER: `,6/ a.2i4z4 ' PHONE NUMBER: 92t -, r 7-3 8 MAILING ADDRESS: 5e21-0 C (Street) (City/State) (Zip) CONTRACTOR:// "( C45 S t/YcP j LICENSE NUMBER: g(6-41_55 PE ONE NUMBER: 922-370 ✓ MAILING ADDRESS: 5r./ ( ,t) /'cz.-L^-l-' (Street) DESCRIPTION (City S/tate) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WQQ0STOVEMBI=IT>><><>_:;<>=~=>:=:::<::::>:»>::::::::_:::>-:>: GAS WATER HEATER GAS: EQUI M IVT` 100 000 BTU O CL ES GAS EQUIPMENT +100,000 BTU DUCTWORK) BOILER/REFRIG 1-100M BTU B. > ILER/REFRI i l:01;;:::.. M BOILER/REFRIG 501-1,000M BTU B.:_ 1L 3EFFIIG 1' IO0I- t,750M BOILER/REFRIG +1,750M BTU HEAT PUMP & AIR CONDITIONER 3-15 TONS H EAT PUMP &: AI <CONOITIO ER y a'` ..O TOt4S' HEAT PUMP & AIR CONDITIONER 30-50 TONS HEAT>PUMP 'AI GC 1 DIT VENTILATING FANS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) .:::::.:::::::........:..:::::::....................................................... .......... CLOTHES DRYER GAS LOG ::..:........................................................................................... MISCEL ►NEOU.S::_ OTCO l ED £L$E' NH)_AE_ UNLISTED GAS APPLIANCE <400,000 BTU IN USED APPLIANCE <400,000 BTU .............................................................................. USEI) APP[ ANCE BTU AIR HANDLER <10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE '2 2 6 (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 = /0 , 31-c) SUBTOTAL $ //, e' PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ j�`("0 Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)-456-3675