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1991, 11-20 Permit App: 91008067 Gas Log, PipingMtC;I1ANIUAL t'bHMl I ArrLI(A i ION f"V1iM rte. --Information Worksheet JOB STREET ADDRESS: �i;S &w i SI V (t=utu CITY/STATE/ZIP: `,,-*/-1(---�� �� �= i`'4- '7' OWNER: ` -141--1 j j•%/!'� i - MAILING ADDRESS: S-A t' PARCEL NUMBER: PHONE NUMBER: 2 - "1/3-3- (Street) 1/-j- (Street) (City/State) (Zip) CONTRACTOR: MARTIN SHEET METAL INC. LICENSE NUMBER: MARTISM174KW PHONE NUMBER: MAILING ADDRESS: BLDG. 103 SPOKANE INDUSTRIAL PARK SPOKANE, WA 99216 (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODSTOVE/!NSERT GAS WATER HEATER:::::.:...................._............................ ..................................................... GAS EQUIPMENT <100,000 BTU (INCLUDES GAS EQUIPMENT +100,000 BTU DUCTWORK) GAS PIPING (EA>OUTLET} BOILER/REFRIG 1-100M BTU BOILER/REFRIG` `I 01-500Ml BTU BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG 1,0001-1,750M BTU BOILER/REFRIG +1,750M BTU HEAT PUMP &`AIR CONDITIONER"0-3 TONS HEA, PUMP & AIR CONDITIONER 3-15 TONS HEAT PUMP &'AIR CONDITIONER`15-30 TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS • HEAT PUMP & AIR CONDITJQNER +50 TONS VENTILATING FANS" EVAPORATIVE` COOLERS . TYPE I HOOD (PER 12' OR 12'. PTN. OF HOOD). . CLOTHES DRYER GAS LOG MISCELtANEOUS.(NOT COVERED ELSEWI-E� UNLISTED GAS APPLIANCE <400,000 BTU UL1NSTED OAS APPt::UANCE 4O0,U0Q USED APPLIANCE <400,000.BTU USEo APPLIANCE O,O00 gTU AIR HANDLER <10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE 'U)t ` �� _.k.: .F,i (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT 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 = x60.00 = x 10.00 = x10.00 = x50.00 = X10.09 , x-10.00:_ x.10:00= x 10.00 `.. . x10.00 = x50.00 = x100.00 = .x50:00 =.:: x100.00 = -- --- ----- .. , - iC t CA, ,' x12.00 = x 15.00. =_- SUBTOTAL $ I / C 6e' PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE_ $ , C1' 6a :` SpW_ lane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675