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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