1990, 11-09 Permit App: 90006050 Gas Log, PipingMECHANICAL PERMIT APPLICATION FORM
Informaticn.WSrksheet
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CITY/STATE/ZIP: 1 PAij.CEL NUMBER:
O E -R: �Y/��1 C-4 OVA PHONE NUMBER:
MAILING ADDRESS.
(Street
CONTRACTOR: I"-fl72 \Sl ,Ku `e LICENSE
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MAILING ADDRESS:P. Kw/ v `Q.VI
(Street)
ill
(City/State) y (Zip)
NUMBER:,
NUMBS 4/ -'er
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(City/State)/ (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE /
DESCRIPTION
NUMBER
OF UNITS
X EACH
-NIT
= AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER •
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 -'4 OUTLETS)
GAS PIVING (5 OR MORE. EACH:)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
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 COVERED ELSEWHERE)
UNLISTED GAS APPLIANCE <400,000 BTU
UNLISTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
/
/
$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 4.00 =
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
10•W
NOTE:
SIGNATUR
MU PE
P E IS $35.00
2
SUBTOTAL /
s l 4 . GU
PLUS: PROCESSING FEE
+ $ ' 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= sa9.cV
Spokane u'ounty Department of Building and Safety
1303 Broa'way Avenue Spokane, WA 99260 (509) 456-3675