1992, 12-03 Permit App: 92010636 Gas Log, PipingMECHANICAL PERMIT APPLICATION FORM %r, //�' -������
Information Worksheet l�-'P C�4et5
JOB STREET ADDRESS: 4/ b03 + [SOS /e, ti/D2 L
CITY/STATE/ZIP: Sp) ne _ W ►'r- PARCEL NUMBER: 115-1... d16 3
OWNER: Dc )? -1C' V1 FA. C2c.y PHONE NUMBER: 9 a'7 -
MAILING ADDRESS:
(Street)
(City/State) (Zip)
CONTRACTOR: Cow) icorQ j FSS . LICENSE NUMBER: Co- ill -m/ 4 Soa
PHONE NUMBER: ?-2.6 -22 ,
MAILING ADDRESS: , `I d / 4 pl optr6, a,r.e y .5(1?,) f(osx 1At A 4' 9 c? _f
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
•
;••�'�at!4!Lif:� :r}tIfttt
BOILER/REFRIG 501-1,000M BTU
:• •v:;::�:.::_J:<i:•a<•y.:: �..
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
tsiCA:1!::fit?Yk:frizz`•M`:>x:titi, .ir
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
.: .................................::::::::::
•
GAS LOG
::► ,:F\7Vi•-•%, \l al! tiI4/;�7:i: 1a1 CY IY:.' CLQ► >�� B CW
UNLISTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x1.00 =
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 =
D.
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
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