1991, 11-25 Permit App: 91008190 Gas Log, PipingMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: 1.1( -
( / I M tiAul `F
CITY/STATE/ZIP: -S/0 (I �.a n c f LA/A . l g 2-/ in
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opp (/'I 1 sst,m. praes
G Ly
PARCEL NUMBER:
OWNER: RO6,�s t9 h I ke .I3eR1 PHONE NUMBER: 91.7- 94"2r (}t,PC/r No, VW(
L OC( , (9z/6
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MAILING ADDRESS: /- [((of ( P(A n)
(Street)
CONTRACTOR: Oa %rPA' ( y
MAILING ADDRESS: /f- ?MO Q no a/U/ay
(Street)
DESCRIPTION
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( Y/State )
LICENSE NUMBER:
(Zip)
PHONE NUMBER: c/Z.Z • Z M U 1/
Sik, a,/a, 9ziz
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT.:':
GAS WATER HEATER
GAS EQUIPMENT <100,000 BTU (INCLUDES,,,
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET) - -
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 101-500M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,0001-1,750M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 0=3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 15-30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP& AIR CONDITIONER 450 TONS
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD -.
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUSs(NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE>400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE:>400,000 BTU
AIR HANDLER <10,000 CFM RECEIVED
AIR HANDLER >10,000 CFM
t\;ti'.! Cl , 1QQ i
i; t) -
BUILIJINU & 5AFEE'((Y
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 =
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 =
x 15.00 =
(
I
SUBTOTAL
$ //
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ ?6 --
SIGNATURE.)
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675