1993, 09-23 Permit App: 93008731 Gas Log, Pipingq9 f 2.02.05 MECHANICAL PERMIT APPLICATION FORM
Velab S Z Information Worksheet
JOB STREET ADDRESS: 1 y C// Gam. (a 7L00/0
13- goal
CITY/STATE/ZIP: 570 bra J (.1X- PARCEL NUMBER:
OWNER: 'nlL F t ?SPS PHONE NUMBER: c/ct?X -a6to7
MAILING ADDRESS: (SG cr.
o
(Street)t���(City/State) % (Zip)
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CONTRACTOR: `L,{ f/'� �tc_d , LICENSE NUMBER: U, tLi 24 PC_ la I Don
�/ acs --8,s- PHONE NUMBER: 5Jc/0 • 3CD/
MAILING ADDRESS: �Y O. BO/. c ,Ob a/1 -e Let-- g9
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODS.OVE/INSERT
GAS WATER HEATER
GAS EQUIPMENT z100,000BTU (INCLUDES
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET)•
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 101 500M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,0001 1 750M BTU3:
BOILER/REFRIG +1,750M BTU
NEAT PUMP & AIR:.CONDITIONER 0=3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
..........................................................................................................................
HEAT PUMP & AIRCONDITIONER 15-30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEATIiEigiAr PUMP & AIR CONDITIONER +50 TONS
VENTILATING FANS
EVAPORATIVE COOLERS .
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II H. OOD
CLOTHES DRYER
RANGE
.GAS LOG
.........................
....................
IMISCELLANEOUS;(NOTCOVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE>400,000'ETU
USED APPLIANCE <400,000 BTU
USED APPLIANCE>400,000BTU
AIR HANDLER <10,000 CFM
AIA ANDLER>10,000 CFM'
NOTE: MINIMUMERMIT FEE IS $35.00
SIGNATURE ! am
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x60.00=
x 12.00 =
x 20.00 =
x25.00 =
x 35.00 =
x60.00 =
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 .
/
/ DO
/
/ U. Q3
SUBTOTAL
$ p.G7
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 3y a'
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
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