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1991, 03-27 Permit App: 91001413 Log, Piping, AC
MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: S, 3 -D 7 Zoe r.,T CITY/STATE/ZIP: ,3 d�(j�/l�`' PARCEL NUMBER: OWNER: le; ,;i%g/ir PHONE NUMBER: MAILING ADDRESS: .99/27,9' (Street) CONTRACTOR: /P'(/34923-7, (City/State) LICENSE NUMBER: PHONE NUMBER: (Zip) MAILING ADDRESS: � /7 a 3 lolficf - (Street) ity/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOOD..................STOV..................../IN................................................................................... GAS WATER HEATER :..:::............ UIPMENT 100, BTU (INCLt DES GAS EQUIPMENT +100,000 BTU DUCTWORK) GAS; PIPING (EA OUTLET} • BOILER/REFRIG 1-100M BTU BOivREFI IG 101.-500M ...::................................:............................::...::::..:......................................... BOILER/REFRIG 501-1,000M BTU BOIL / EFRIG 1,11001 '1,750M BOILER/REFRIG +1,750M BTU HEAT PUMP,& AIR +CONDITIONER 0-3 TON$... HEAT PUMP & AIR CONDI1 ONER 3-15 TONS HEAT tUiP & AIR..CO.NDITIONER15 30 TONS: .................................................................................................................... ...................................................................................................................... HEAT PUMP & AIR CONDITIONER 30-50 TONS ...................................................................................................................... HEAT` PUMP..& AIR CONDITIONEF +50 TONS ....................................................................................................................... VENTILATING FANS ................................................................................................................. EVAPORATIVE,COO ::RS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPE II HQQD:......`.:;; CLOTHES DRYER:.::.:::............................................................... .................................................................. ........................ RANGE:::;::: ........................ ...................... GAS LOG ..........:::::.............::.:::..::::. UNLISTED GAS APPLIANCE <400,000 BTU �AS:APPL,IAI�IOE >400 USED APPLIANCE <400,000 BTU AIR HANDLER <10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 (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 = /f/ f 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 = x10.00 = x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x15.00 = ` 2 SUBTOTAL $ .rj PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE d =$ �9 SIGNATURE Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675