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1990, 07-09 Permit App: 90003183 Gas LineMECHANICAL -PERMIT ,APPLICATION FORM Information Worksheet JOB STREET ADDRESS; Mmye/and Z-�ve CITY/STATE/ZIP: 5POk4h e a 91A 97 ./2 PARCEL NUMBER:_ OWNER: V PHONE NUMBER: O 78'7 MAILING ADDRESS: E, 1v2�/ /yoY�AQ'`7c� 15y+/Ye e (Street) ( ity/State) (Zip) CONTRACTOR A/ Gi% l LICENSE NUMBER: PHONE NUMBER: OSO D MAILING.ADDRESS: (Street) (City/State) (Zip) ,.MECHANICAL. WORKSHEET/FEE f.; DESCRIPTION SCHEDULE NUMBER OF UNITS . X EACH ITNIT = AMOUNT DUCTWORK,SYSTEM _ _ _ _ WOODSTOVE/INSERT _ _ _ _ GAS VATER ,,HEATER _ _ _ _; HEATING`>EQUIPMENT <100 000BTU _ Q , HEATING 'E UIPMENTr'+1Q0 000 'BTU, ,< AS :.PIPING,. (EA`O REFRIGIIQOMBT[Jy(NOT A/COR HEAT PUMP). REFRIG. �0].SO,OM BTU�` t _ REFRIG,,,5$1 a00M:BTiJ y REFRIG 1 REFRIG HEAT PUMP&#AIR=CON.DITIONER:O 3;.TONS HEAT;' PUMP" &x{AIRi CONDITIONER` 3.-15?•TONS - HEAT .PUMPSkµ&:AIRCONDITIONER: 15-30.TQNS HEAT PUMP,& «-AIR�'Ct7NDITIONER;= 3050: -,TONS -: HEAT :PUMP &r,AIR!:CONDITIONER..+50.:.TONS - _' VENTILATING.:FANS - - EVAPORATIVE`COOLERS -_ -_ _ - _ _ _ -_ _ _- TYPE I YHOOD (PER: .12: OR. 12';-PTN. OF.. HOOD) TYPE II HOOD _ _ _ _ _ _ CLOTHES -DRYER 77. RANGE '' -----------,- GAS LOG ----_-_-_-_-_-_-_--_-__ MISCELLANEOUS .(NOTCOVERED 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$10.00 = = x 25.0077 x .10.0 0 = 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 12:0C _ 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 = - NOTE: MINIMUM PERMIT FEE IS $35.00 SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE _ $ SIGNATURE Spokane County Department of Building and Safety West 1303 Broadwav Avenue Spokane, WA 9260 (509) 456-3675