1991, 02-14 Permit App: 91000514 Gas Log, PipingMNIC
ECHAAL PERMIT APPLICATION FORM /bad/ 9
Information Worksheet //ice
JOB STREET ADDRESS:' 7, D7 C /�v 'e;-,c/� `�,` 16
CITY/STATE/ZIP: '5,Q/4_e C/9212
(la kite ce /h0_2
OWNER:
MAILING ADDRESS: s2,.ti
(Street)
PARCEL NUMBER:
PHONE NUMBER: ?.2g - /00 Z
(City/State) (Zip)
CONTRACTOR:4-/ �9a5 Sei,•vicp 6 i4ta/r LICENSE NUMBER: /}-/cm 6-4$52/ory2K
PHONE NUMBER: 92a-370"/
MAILING ADDRESS: 5 / ( AJ- � e.,•/_,_/v r.e 95zpC
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
DESCRIPTION
= AMOUNT
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER
GAS EQUIPMENT <1000,000 BTU (INCLUDES
GAS EQUIPMENT +1000,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 101-500M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,001-1,750M 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 I 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
UNLISTED 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
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 =
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 =
c5"0
%C9 . eke
NOTE: MINIMUM E IT FEE IS $35.00
SIGNATURE /f M *
Spokane County Department of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 36-0-0