1992, 08-20 Permit App: 92006678 Gas LineMECHANICAL PERMIT.APPLICATION FORM �� n
Information Worksheet + ' S y 5�
JOB STREET ADDRESS: 14 /, V I f (1
CITY/STATE/ZIP:7II70C F N 0 rte. PARCEL NUMBER: SO 1 .5. .6.---7)e--r?
OWNER: 611-A. 111a kna.rd PHONE NUMBER: 01.
MAILING ADDRESS' 1(08. E -z-NGti[Rn#_ J.i,D_
/ (Street) (City/State) (Zip)
CONTRACTOR: J fort` AL 1.._ 1144A. q `('Au LICENSE NUMBER:
PHONE NUMBER: / 6 7 p3 4'y
•
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
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/WHIG 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 15-30TONS;::
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP &=AIR CONDITIONER +50 TOW' :`` '.
VENTILATING FANS
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
ULINSTED 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
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(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 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
4,
1
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675