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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