1992, 03-17 Permit App: 92001587 Gas Log/c' 4-4,s- /�-4C,
MECHANICAL PERMIT APPLICATION FORM
Informalien Werksheet _
JOB STREET ADDRESS: i %T 7/1
Cl l�/n%�" C
.Lc)4 4 bZ/6 PARCEL NUMBER: Ye ,
OWNER: [. PHONE NUMBER: 4) ii 7e21- g
MAILING ADDRESS: C 1g7/7 D6.mioil.. .S . 44 991s2fi
(Street) V (C y/State) (Zip)
CONTRACTOR: Z_C.4 77 ()i- /S LICENSE NUMBER: CO I- 360 - z(-6-3
,/ a'lPHONE NUMBER:2q{- x617
MAILING ADDRESS: PCS 6446/5/7T SA. hilt" 57 's.S/7)(
(Street) / (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE C-76.2- a Oe,4
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER
GAS: EQUIPMENT<100000 BTU `(INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET)
BOILER/REFRIG 1-100M BTU
poi LER/REFRIG:1:01-500M BTU.
BOILER/REFRIG 501-1,000M BTU
......................................................................................................................
BOILER/REFRI x:,0001' 1,750M BTI ..
BOILER/REFRIG +1,750M BTU
•
HEA'i Pt1MP�'&:AI`RCONDITIONER..TONS;;
HEAT PUMP & AIR CONDITIONER 3-15 TONS
•
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEST PUMP $_� AIR ONDITIONER:+50 TONS
VENTILATING FANS :::,....._.........................................._....
EVAPORATIVE COOLERS ..... •.` ....
TYPE I H000 (PER 12' OR 12' PTN. OF HOOD)
CLOTHES ONVEIR
RACK
GAS LOG
IMSCELLAMEOUS p1OT COVERED ELSEWHERE
UNtJW GAS APPLIANCE <400.000 BTU
lA/ SUD GAS APPLIANCE >400.000 BTU
USED APPUANCE <400.000 BTU
,USED APPLIANCE A00 BTU
AIR HANDLER <10.000 CFM
AIR HANDLER >10.000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.03 =
x1.00 =
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 -
x10.00 =
X 10.00 I.
x10.00=
/Q•=
X 10.00 -
x 50.00 =
x100.00 =
x 50.00 -
x100.00 -
x 12.00 =
x 15.00 =
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_ $ 3S' o`
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675