1991, 03-21 Permit App: 91001199 Gas LogMECIIANICAL PERMIT APPI. "CATION FORM
Information Worksheet
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JOB STREET ADDRESS: 5 a 90 7 1 cir //i [.() i' J /-/1Q9
CITY/STATE/ZIP: 5p6kQ r f9a PARCEL NUMBER:
OWNER:
-rep m 3 -)-- Lcf a r �'-
MAILING ADDRESS:
Same
(Street)
PHONE NUMBER: 5 3 5 3069
CONTRACTOR: MARTIN SHEET METAL inc.
(City/State) (Zip)
LICENSE NUMBER: MARTISM170KW
PHONE NUMBER: 924-8088
MAILING ADDRESS: BLDG. #103 SPOKANE INDUSTRIAL PARK SPOKANE, WASHINGTON 99216
(Street)
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
DESCRIPTION
= AMOUNT
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER
GAS EQUIPMENT <1000,000 BTU_ (INCLUDES
GAS EQUIPMENT +1000,000 BTU_ _DUCTWORK)
GAS PIPING (EA OUTLET)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 101-500M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,001-1,750M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 15-30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & AIR CONDITIONER +50 TONS
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12
TYPE II HOOD _
CLOTHES DRYER
RANGE
OR 12' PTN. OF HOOD)
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
O
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 =
/D
NOTE: MINIMUM PERMI FEE IS $35.00
SIGNATURE i2
SUBTOTAL
$ /0
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
oL
=$3g�
Spot., ne County Department of Buildings
Nest 1303 Broadway Avenue Spokane, WA 99260. (509) 456-3675