1991, 12-02 Permit App: 91008274 Gas PipingMECHANICAL PERM&APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: b)00 /e/4a rn-
!P✓
CITY/STATE/ZIP:�kl%i e ,GGg;. 99Zo Ce PARCEL NUMBER:
OWNER: /T/�Y'ca f 7 �a..¢ PHONE NUMBER: p 2 z - 9 %
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER
:GAS EQUIPMENT <100,000:tau (INCLUDES:__::
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS pIPING,(EA:AUTLET}
BOILER/REFRIG 1-100M BTU
;BOILER/REFRIG 101-5OOM8TU
BOILER/REFRIG 501-1,000M BTU
BOILER/AEFAIG 7;fl001-1750M BTU 5 - _ .. -_
BOILER/REFRIG +1,750M BTU
HEAT. PUMP & AIRSCONDmONER0-3 TONS:...,-.
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR: CONDITIONER 15-301ONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
;HEAT PUMP $AIR_ CONDITIONER _450TONS;`:„_;:
VENTILATING FANS
EVAPORATIVEbOOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
,TYP.Eat HOOD':::,: :. ...: .
CLOTHES DRYER
,RANGE
GAS LOG
. .....:..:..:..:::..::::::..
MISCELLANEOUS;(NOTCOVEREDELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
:ULINSTED::GAS APPLIANCE;S00;000STU'`<::^i::.`
USED APPLIANCE <400,000 BTU
USED.`APPLIANCE: 400.000:BTU
AIR HANDLER <10,000 CFM
AIR HANDLER>10,000;CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE?iSet,"
(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 =
x25.00 =
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 =
x12.00 =
x 15.00 =
x
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