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1989, 09-21 Permit App: 89003529 Gas PipingMECHANICAL PERMIT APPLICATION FORM W I,,``Informa�tiion Worksheet JOB STREET ADDRESS: �. � p� UI 9)1) PA CITY/STATE/ZIP:.110C111911 11 C1/I f)( .l (07T DPARCEL NUMBER: 0.76 5-'// /�/7"5-I 0/C2E- OWNER: j✓( LI� Mel I I 0 �1.� IBJ PHONE NUMBER: Zig' `�/`2‘ MAILING ADDRESS: CONTRACTOR: (Street) (City/State)//(Zip)p) LICENSE NUMBER: 1''�r/�rI''``U /i 1 1r 6�Jma PHONE NUMBER: �l'W) `14000 MAILING ADDRESS: C . " )', ) ( Unl.xt n 1 ripe (AV') OW) (Street) (City/Sthte) (Zip) MECHANICAL DESCRIPTION WORKSHEET/FEE SCHEDULE NUMBER X EACH OF UNITS UNIT = AMOUNT DUCTWORK SYSTEM WOODSTOVE/INSERT GAS WATER HEATER HEATING EQUIPMENT <100,000 BTU HEATING EQUIPMENT +100,000 BTU GAS PIPING (1 - 4 OUTLETS); GAS PIING (5 OR MORE. EACH:) REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) REFRIG 101-500M BTU REFRIG 501-1,000M BTU REFRIG 1,001-1,750M BTU REFRIG +1,750M BTU HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER VENTILATING FANS EVAPORATIVE COOLERS TYPE I HOOD (PER 12' OR 12'PTN. OF HOOD) TYPE II HOOD CLOTHES DRYER RANGE 0-3 TONS 3-15 TONS 15-30 TONS 30-50 TONS +50 TONS GAS LOG MISCELLANEOUS (NOT COVERED'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' 1 x$10.00 x 25.00 x 10.00 x 12.00 x 15.00 x 4.00 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 goo NOTE: MINIMUM PAT F4 IS SIGNATURE 1A/i/ SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE _ $ 2G co 1 3 03 Broadway Avenue Spokane County Department of Building and Safety West Spokane, WA 99260 (509 ) 456-3675