1992, 11-23 Permit App: 92010297 Gas PipingMECHANICAL PERMIT APPLICATION FORM
9 Inform ,tion Worksheet
JOB STREET ADDRESS: N, 17 I l I- or_
CITY/STATE/ZIP- PARCEL NUMBER:
OWNER: (;, Iti'ri Var, ?l rocPHONE NUMBER: cd '7 9S
MAILING ADDRESS: IV • 17') /-o c H 5'f
(Street)
cnAA'6nne, (,l 571',) 0(n
(City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
4VO:00010.1MS0%11' <ss<'`
GAS WATER HEATER
G"xalka1JlPMCaN i00 0t"1<t TaLUC ESk
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAriP1NG�a
��•<'"r.�a��<.>s
BOILER/REFRIG 1-100M BTU
NifielafireatvWk[
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
�...
tt g i?11 ijµP;"&„ lgai figlph
HEAT PUMP & AIR CONDITIONER 3-15 TONS
),H "f kakt i ,LCINDIT C) : I i5 1' 1 ' W
HEAT PUMP & AIR CONDITIONER 30-50 TONS
H A i?tl6itpi AfF p ligiNNtlea.0 70 0:
VENTILATING FANS
cu.JFw„�»:bng.c:raF,J"':%a:�:..x,::ax2wi
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
» r F'fi :X:M YgcN<:iY<n[0.v........... .........�...........
CLOTHES DRYER
GAS LOG
>MCSC CiisAT1S4050.Cl!"09.4 3 Et SEWHE
UNLISTED GAS APPLIANCE <400,000 BTU
Ur I.N$TED GAS"AP.eLtANCE.>a0o o0013TI»
USED APPLIANCE <400,000 BTU
USE D APPcIANCE„aa.00}900.8
AIR HANDLER <10,000 CFM
AIR HANDLER;>104000:CFM':i
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(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 =
x12.00 =
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 =
x10.00 =
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