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