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1992, 12-23 Permit App: 92011135 Gas Log, PipingI3 MECHANICAL PERMITAPPLICATION FORM C Z •� Informer ion Worksheet JOB STREET ADDRESS: L • Hew a CITY/STATE/ZIP: CI C.sl .SLS Jeno_ 99a -0(o PARCEL NUMBER: OWNER: .SbInvi 960.h4c. //�� PHONE NUMBER: /��-t-}%4'I0 MAILING ADDRESS: SII (Street) CONTRACTOR: i `-21 1 c r: CT/ !-1 IZOC: ,! Cif/if Fr2 MAILING ADDRESS: E • (;31n 3r?4Ji.lP (City/State) (Zip) LICENSE NUMBER: rA ICC) 6,C.)-13 b l.( PHONE NUMBER: (5q) CUL- S.'i / I i(HAI J.� c/9 c&-. (Street) , (City/State) _MECHANICAL WORKSHEET/FEE SC::EDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE.SYSTEMS): • YJOODSTOVE/1NS.RT-.:...- - : GAS WATER HEATER GAS.EQUIPMENT<100;000 BTU.:(INCLUDES_ _"':- GAS EQUIPMENT+100,000 BTU DUCTWORK) :GAS PIPING (EA OUTLET BOILER/REFRIG 1-100M BTU EOlL nJREFRIG 101-500kiBTU EOILER/REFRIG 501-1,000M BTU BOILER/REFRIG _1,0001_1;750M BTU `i:; '_ „;-- ::'r.:: . EOILER/REFRIG +1,750M BTU ._. ''-'"r P` MR&'AIR COND;TION-(-'.'1-3 TON.: HEAT PIJMP & AIR CONDITIONER 3-15 TONS • -- --' :HEAT RUMP &MAIR CONDITIONER 15-30 TQNS[ HEAT PUMP & AIR CONDITIONER 30-50 TONS-- - HEAT PUMP&AIR CONDITIONEP.:+SOTONS>':` VENTILATING FANS . EVAPORATI`JE COOLERS_ TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) ;TYPE II;HOOD CLOTHES DRYER GAS LOG :MISCELLANEOUS(NOT COVERED:ELSEWHERE:_ UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED GAS APPLIANCE >400,000 BTU USED APPLIANCE <400,000 BTU USED: APPLIANCE>400,000BTU ; :::: AIR HANDLER <10,000 CFM AIR HANDLER,>10,000 NUMBER OF UNITS. X EACH UNIT = AMOUNT 1 x-10.00 x 25.00 = x 10.00 = x 1200 = x 15.00 = x 1.00 x12.00 = x 20.00 =- x25.00= x355.00= x 60.00 = x 12.00 =. x20.00 = x 25.00 =. x 35.00 = x 60.00 = x 10.00 = x 10.00 = x 50.00 = x 10.00 = x 10.00 = xi0.00= x10.00 = x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = 10,00 NOTE: MINIMUM PERMIT FEE IS $35.00 SUBTOTAL PLUS: PROCESSING FEE $ 1, nob + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE _S 300 SIGNATURE Spokane County Division of Buildings :14r�