1993, 03-23 Permit App: 93001739 Gas Log, Piping35
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: i"1 .._20.20 E lC%
CITY/STATE/ZIP: r5� CX t A. ( Z(_.. PARCEL NUMBER:
OWNER: t -*:i t { t E - ', PHONE NUMBER:
MAILING ADDRESS: -'x.; C,
g 3-037
1.:"op
(Street)
CONTRACTOR: (Ct i j � ` r �f P;
MAILING ADDRESS: -
DESCRIPTION
(Street)
(City/State) (Zip)
LICENSE NUMBER: l i C)cf �'i /.JL/
PHONE NUMBER: ` ; 3 U - Al 3 (il
t t_. �;
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
ooDSTOVE/INsERT
GAS WATER HEATER
GAS I"QUIPMENT <100,000 BTU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,0001-1,750M 8
BOILER/REFRIG +1,750M BTU
HEAT PUMP ► AIR CONDITII NER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP &.AIR CONDITIONER;
VENTILATING FANS
3-15 TONS
15-50 .TONS
30-50 TONS
+5tl TONS<'><
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
MI.SCELl.AN1*QU$ (NOT COVERED LS WHEI
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTSD. GAS;APPLIANCE >400,000 RTU .:.:.
USED APPLIANCE <400,000`BTU
..,.4.5!.1,5.,555•:1,.:.;,•...,55.•....5:.: �.!.{: l,.:. :.:::::::.::: n:•:: � :. :! :..:.� :..
l S D APPLIANCE >400,000 BTU
„
AIR HANDLER <10,000 CFM
AI,R`.HANOLER >1.0,000` M
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE t4 (7/ _ >/t5
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x12.00 =
x 15.00 ._
x1.00 =
/(`)L,
x 12.00 =
x 20.00 =
x25.00 =
x 35.00 =
x 60.00 =
x 12.00 ="
x 20.00 =
x25.00 =
x 35.00 =
x 60.00 =
x 10:00 =
x.10.00 =
x50:00 =
x 10.00 =
x10.00 =
x 10.00 =
x10.00 =
/
; • 0_'
x 10.00 =
x50.00 =
. x100.00=
x 50.00 •
x100.00 -
x 12.00 -
x 15.00 -
SUBTOTAL
$ R ? CO
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 310 0-5'
Spokane
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675