1991, 12-03 Permit App: 91008339 Gas Log, PipingJOB STREET ADDRES
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MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
S 2/(5
CITY/STATE/ZIP: Y NI(/14z-
OWNER:
.l1tOWNER:
MAILING ADDRESS: tal
CONTRACTOR: %1((P0Atll
69,39
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PARCEL NUMBER:
PHONE NUMBER: Qi21.° -:=®b2
ti 2:z &ta n w ir, w q- &W I to Gi,h . q w.z
MAILING ADDRESS: K MCP
(Street)
col „ty
DESCRIPTION
Sre 4.[(4 rt
(Street)
(City/State) (Zip)
LICENSE NUMBER: A)47 -i 0CS /013 K rJ
PHONE NUMBER: (2,2-2000
SPk,()IA. 99ziZ
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER
GAS EQUIPMENT <100,000 BTU (INCLUDES
GAS EQUIPMENT +100 000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 101-500M BTU -E,
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,0001-1,750M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 0 3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR :CONDITIONER 15-30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & AIR CONDITIONER +50 TONS
VENTILATING FANS
.....................................................................
St EVAPORATIVE COOLERS
TYPE 1 HOOD (PER 12' OR 12' PTN.
...........................................
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOTCOVERED 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,2LA124;AA
(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 =
x10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
/
I
10,90
SUBTOTAL
$ /040
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ 3t t) V
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675