1993, 01-27 Permit App: 93000407 Gas Log, PipingMECHANICAL PERMIT APPLICATION FORM
Information Worksheet �"�]�
JOB STREET ADDRESS: /�.I -1 7.2 3 L2 l V1 AY\ 1 0
CITY/STATE/ZIP: Cu'CJ eC4~ I a 1 12/ to PARCEL NUMBER: q
OWNER: LAXA rV.tit�{ZQr PHONE NUMBER: (2 7 - e
MAILING ADDRESS:
CONTRACTOR: ERZ ) ^ '`
(Street) (City/State) (Zip)
CI!?i nr•.1J (1f ifti2 LICENSE NUMBER:LL
MAILING ADDRESS: •
r"} J:7 F r rr (
(Street)
PHONE NUMBER: (_`i(-%ci) i._?(,- `i I I
rr
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARAT7 SYSTEMS)
WOQDSTOVE/IlS R
GAS WATER HEATER
GAS EQUIPMENT<1 O0000 BTU(INCLUDE
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS PIPING (EfkOUTLE I:)
BOILERJREFRIG 1-100M BTU
E.Oft. P1REFRlG: of SOOM T
BOILER/REFR!G 501-1,000M BTU
SOLE /REFRIG 1,0001 1 750M BT
EOIL ERJREFR!G +1,750M BTU
-PJM u AtR CO Di IO I� R 0-3 i ONS
NEAT & AIR CONDITIONER 3-15 TONS
HEATPUMP &'AIR<CONDJTIONER-15-30 TON
HEAT PUMP & AIR CONDITIONER 30-50 TONS -
HEAT_PUMP & AlR CONDmTRONER +50 TONS
VENTILATING FANS ._.:::. ,....•
...._.
f POi3ATIVE COOL=F 3
T YiPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
• YPE'IIHOOD
CLOTHES DRYS 1
GAS LOG
MISCELLANEOUS (NOT COVERED FLSEWHER
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE 100000 BTU
USED APPLIANCE <400,000 BTU
usEp_iNpFLIANQE. 00,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
Pp)
NUMBER X EACH
OF UNITS
UNIT
AMOUNT
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x25.00 =
x 35.00 =
x60.00 =
x 12,00 =_
x 20.00 =
x 25.00 =
x35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x50.00 =
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 =
L. PLUS: PROCESSING FEE
-too
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_ l9 CO
Spokane County Division of Buildings