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1991, 01-04 Permit App: 91000042 Gas PipingJOB -STREET ADDRESS: CITY/S OWNER: MAILIN MECHANICAL PERMIT APPLICATION FORM Information Work heet 1 //// i\ f I., /n -„n - NUMBER (Street) CONTRACTOR: LICENS E NUMBER: q2 (City/State) (Zip) NUMBER: PHONE NUMBER: MAILING ADDRESS: .(Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE DESCRIPTION - SCHEDULE NUMBER OF UNITS X EACH UNIT = AMOUNT DUCTWORK SYSTEM_ WOODSTO _ /INSERT-. - - - - GAS WATER _HEATER - -_ - -_ HEATING --E ,100, 000 BTtJ t ti =• _ ; , _ ; HEATINGEQUIPMENT,+100,000 BTU 1, -� GAS PIPING.-, REFRIG ;1-1OOM BTQ A(NOT ,A/C "OR HEAT; PUMP)"�" ,: REFRIG 101-500M -BTU - �, � :, T-, _- REFRIG 501-1DOOM =BTQ_ �r REFRIG 1-001-1 750K,1=4 REFRIG ;�-1, 750M BTU , ... > r r r:- -..- HEAT`PUMP , &,'AIR ;CONDITIONER 0=3i'�TONS Y 3 - HEAT PUMP & .AIR . `CONDITIONER 3 ='15 '_TONS ° _ x 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 TAG MISCELLANEOUS (NOT COVERED ELSEWHERE)—m- UNLISTED GAS.APPLIANCE <400,0.00,BTU_ UNLISTED GAS APPLIANCE >400,000 BTU .- _ USED APPLIANCE <400,000 BTU_ - _ _ _ _ _ USED APPLIANCE >400,000 BTU_ _ _ _ _ _ _ AIR HANDLER <16,000 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 ;60 00 X �l2.00 x= 2 0.00.. x.25.00. x 35.00 = . x 60.00 = x 10.00 = x 10.00 = x 50.00 x 10.00. _ x 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 = e < a= ��� t : r ::� r - '. �:... ;... SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT NOTE: MINIMUM PERMIT FEE IS $35.00 FEE DUE _ $ SIGNATURE Spokane County Department of Building and Safety West 1303 Broadwav Avenue Spokane, WA 9260 (509) 456-3675