1991, 11-25 Permit App: 91008191 Gas Log, Piping' E) H l� a s q MECHANICAL PERMIT APPLICATION FORM , 9 l - �) l l
Q .t o N A �1 8 I I o Information Worksheet "- n t,
JOB STREET ADDRESS: W V 1 t3 ✓1 �y r b‘17 7. l deck mo trill
CITY/STATE/ZIP: SAO k k /A - V Q Z 1 z- rpARCEMBER
OWNER: TOin.-kd J i^1 1- L PHONE NUMBER: 9rp6 _ 9 -Y ---i 0
MAILING ADDRESS: 7 i t9 7 /k& ✓L'j DWI Q r'I/ S A-7 Wit - ("9 2/
(Street) (City/Stat4)
CONTRACTOR: kkk-it'0,40(/ G'"1,r ,, t 1'
MAILING ADDRESS: X- 7ff«' R!-uaiu/( y
(Street)
DESCRIPTION
LICENSE NUMBER:
(Zip)
PHONE NUMBER: l 2-d,0
S/O (2 /,. - 7-/2
(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 +50 TONS,
VENTILATING FANS
EVAPORATIVE COOLERS ::::°' `. I:: :- . -
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
ULINSTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000:BTU x -E C. E ! It! D
AIR HANDLER <10,000 CFM
AIR HANDLER>10,000 CFM NOV 2 51391
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 =
x20.00 =
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 =
x10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
/
/
/-
/
�c•-- `o
SUBTOTAL
$ /, -
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ 06 a"
SIGNATURE .j��
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675