1991, 02-12 Permit App: 91000466 Gas Log, PipingMECHANICAL PERMIT APPLICATION FORM 0 p P HW
Information Worksheet J
JOB STREET ADDRESS://42/0- ,1 0V /1 IVQ_J/
CITY/STATE/ZIP:9 die aM <-- hot (? PARCEL NUMBER:#/4-31
/ - a -OA
/3#7
, • --rt-x PHONE NUMBER: %� 0 _7 l -53 9 665-3
MAILING ADDRESS:
(Street)
GiI��T4ClC ra.PK J1e
OWNEB.
%��a�/'%��( vt /j B,c/c7tra ,2,4o&
CONTRACTOR:
MAILING ADDRESS: PO BOY
(City/Sta ) (Zip)
LICENSE NUMBER: nQtCLLT 4; 3) 01,10
PHONE NUMBER: 53$ - 264
(Street)
5P07A/VR- PA 9,220
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT
DUCTWORK SYSTEM
WOODSTOyE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000,BTU
HEATING EQUIPMENT'+100,000.BTU
:-+ GAS PIPING;-(EA'.OUTLET).
4REFRIG; 1-100M„BTU`>(NOT'A/C,OR
REFRIG 101-500M BTU
REFRIG 501-1,000MRBTU_”
REFRIG-1;601-1450M,067•
REFRIG;+1,750M BTU"
HEAT' PUMP ,&
HEAT -PUMP&
HEAT PUMP.&
▪ HEAT PUMP &
. HEAT 2UMP &
VENTILATING
EVAPORATIVE
HEAT PUMP).
= AMOUNT
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00
4 x 1:00 =
x 12.00
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
COOLERS .
TYPE -I HOOD (PER 12' OR
' TYPE II HOOD",
12'
PTN. OF 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
x 20.00 =
x:.25.00.=
X 35,00'.=
x 60.00
x,12.0C =
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 =
O C) Q
NOTE:ZMUM,PERMIT FEE IS $35.00
SIGNATURE
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
SUBTOTAL
$ /3)00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= s_37.o0