1990, 12-11 Permit App: 90006694 Gas Log, PipingJ03 STREET ADDRESS:
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
E. , ckt01 Nkaiii
CIT_/STATE/ZIP: Sew...AAA
OWNER: BE.2N 12. £ Pj n i,i,✓
MAILING ADDRESS:
CONTRACTOR:
PARCEL NUMBER: q
PHONE NUMBER: 9 26,-17 9 9
(Street)
U4.PPy PLMQ
(City/State)
LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS: 75'70 ki FAR
(Street)
(Zip)
/Of- 9/728
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
.DESCRIPTION OF UNITS UNIT
DUCTWORK SYSTEM '
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (EA OUTLET)
REFRIG 1-100M BTU (NOT A/COR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG:501-1,000M BTU';
REFRIG 1,001-1,750M BTU
REFRIG,±1,750M BTU
HEAT -PUMP &
HEAT PUMP &
HEAT'PUMP &
HEAT.PUMP'&
HEAT PUMP &
VENTILATING
•
AIR CONDITIONER
AIR, CONDITIONER
AIR CONDITIONER
AIR:CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
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
A
= 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 =
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 =
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
$
Spokane
West 1303 Broadwav A a nue SpokaneBuilding WA99260 Safety(509) 456-3675