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1991, 04-23 Permit App: 91002027 Gas PipingJOB STREET ADDRESS: CITY/STATE/ZIP. PARCEL NUMBER: t)IVO2)CG OWNER: PAI,AI A . 4inhar1�. PHONE NUMBER: .5 Oct Ra -7-c) /111()} ImPrin4_IDA (City/State) MECHANICAL PERMIT APPLICATION FORM Information Worksheet MAILING ADDRESS: S. ((av )shrn,an (Street) l8SL(') 13LI 990 l� (Zip) CONTRACTOR: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) ,WOPOSTOVFANSERTIE GAS WATER HEATER :GAS EQUIPMENT,<100,000HTU(INCLUIDES GAS EQUIPMENT+100,000 BTU DUCTWORK) :GAS PIPING (EA OUTLET) BOILER/REFRIG 1-100M BTU BOILER/REFRIG101-500M-BTU' BOILER/REFRIG 501-1,000M BTU , BOILER/REFRIG::1,0001°=i;75oM"BTU ___ BOILER/REFRIG +1,750M BTU HEAT PUMP & AIR CONDITIONERt0-3TONS HEAT PUMP & AIR CONDITIONER 3-15 TONS :HEATPUMP.&AIR CONDITIQNER;15-30 TONS:..:':: -::: : HEAT.PUMP &AIR,CONDITIONER 30750 TONS HEAT:PUMP:&AIR CONDITIONER +50 TONS VENTILATING:FANS • ' • • ' EVAPORATIVE COOLERS--- - -;€.. TYPE I HOOD (PER 12' OR 12'. PTN.-OF.HOOD) . net 11 HOD <» > s?` i >;i><a_>:';isi:: CLOTHES DRYER: GAS LOG MISCELLANEOf S (NOTCOVERED:wsEWI1ERE;;<. UNLISTED GAS APPLIANCE <400,000 BTU ' UUNSTED GAS:»PUANCC 4004)00 BI USED APP. LIANCE'.<400,000-BTU ,USED APPUANGE 000. BTO AIR HANDLER <10,000 CFM AIR tiANOLER:>1 «000 CFM_':;::' NOTE: MINIMUM PERMIT FEE IS $35.00 (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 =.. x10:00 = x 10.00 = x50.00 = x.10.00 = x .10.00.'=.- -' x10.03•=..- x 10.00 = -- x 10.00 = x50.00= x100.00 = x 50.00 _ x100.00 = x 12.00 = x15:00 =- .. .. ._. _- :...:......, SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE _ $ SIGNATURE Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675