1992, 09-18 Permit App: 92007839 Gas LogJOB STREET ADDRESS: (�
CITY/STATE/ZIP;'al' " c `D \ CMaO(.0 PARCEL NUMBER:
OWNER: --kc \) Q ���`C\PSc, PHONE NUMBER: (("�� \eXO - - %c \
MAILING ADDRESS: T‘ts'YY\
(Street) (City/State) �`p (Zip)
O (n LICENSE NUMBER: V '
PHONE NUMBER: <1-ACQC.o -
MECHANICAL PERMIT -APPLICATION FORM 92- -703i
Information Worksheet
CONTRACTO
MAILING ADDRESS: \\.Th•R`�`�
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT•..:
GAS WATER HEATER
GAS EQUIPMENT K100,000.BTU (INCLUDES
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS -PIPING (EA OUTLET)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG':1014500M.BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG:1, 000.1.-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
EVAPORATIVE COOLERS::'' :-
TYPE 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
SIGNATUR1./ln \ (�
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
Liicx avt
(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
x 25.00 --
x
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 =
x50.00 =
x100.00 =
x 12.00 =
x 15.00 =
1.
‘0.00
SUBTOTAL
$ NO .00
PLUS: PROCESSING FEE
+ $ , 25.00
EQUALS: TOTAL PERMIT
FEE DUE
,
-- N
$ -. W
i6