1991, 05-29 Permit App: 91002952 Gas Log, PipingMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: C !I YO 9 C ha_, e
CITY/STATE/ZIP: ,J`%/ nJ2 97.24
OWNER: /'etbb1 OyG•rn
MAILING ADDRESS: //Se L -t -t -e
PARCEL NUMBER:
PHONE NUMBER:
cap?ct4- 1-
/a_ (603LS
?2Z - 3.‘77 8�
(Street)(City/State) (Zip)
CONTRACTOR:AL/ S &' r,ce t pI LICENSE NUMBER: ii/6/4/45-5/ ((c
7 PHONE NUMBER: 92a 3704'
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER
'GAS EQUIPMENT<100,000_BTU (INCLUDES _
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS PIPING (EAOUTLET)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG.101-500M•
BOILER/REFRIG 501-1,000M BTU
BOILERIREFRIG 1,0001-1,750M 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 i
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 APPLIANCE5:400,000 BTU .'
AIR HANDLER <10,000 CFM
AIR HANDLER>10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(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 T-
x
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x10.00 =
x 10.00 =
x10.00 =
2-,
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
0?&i70
SUBTOTAL
$ 2,0, 0.0
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ yj 6.0
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675