1992, 11-12 Permit App: 92010021 Gas LogMECHANICAL PERMITIAPPLICATION FORM
�'f /� Information Worksheet
JOB STREET ADDRESS: /2,p-/hht &tl-ll21 C
CITY/STATE/ZIP:5,4 XI 41t °19 MC, PARCEL NUMBER:
OWNER: /401.0144,D L.LOYJ PHONE NUMBER:
MAILING ADDRESS: S/A1tit.
(Street) (City/State) q (Zip)p
T 6 E ENTERPRISES INC. rFEV r//9 Op 7 `j/
CONTRACTOR: gNTEPR ISES I LICENSE NUMBER:
SPOKANE, WA. 99207
(509) :83-0504 PHONE NUMBER: C1i13 - 0S017
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
W OOD STOV ElI N SERT i.::.. t
GAS WATER HEATER
GAS EQUIPMENT <100,000
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET)
.:......:....:.....:.
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 101-500M BTU':'.:::
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,0001-1,750MBTU:;
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 COVEREDELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE 400,000. ETU;
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU ;..'',
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE hint/C-5
(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 =
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 =
/
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675