1993, 08-02 Permit App: 93006484 Gas Log, Piping 1q� MECHANICAL,PERMIT APPLICATION FORM �j3
�` �\� Q rr�� Information Worksheet
JOB STREET ADDRESS: (O
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CITY/STATE/ZIP: )OOK-C.4 PARCEL NUMBER:
OWNER: t,C�l..l t Carol )O} L PHONE NUMBER: S3S - -11D33
MAILING ADDRESS: --M-e-nE.-
(Street) (City/State) l ,, (Zip)
CONTRACTOR: LGyy ( .(v(�It�P�� C-0 LICENSE NUMBER: L.Ct i V i ( el ) Drn
R.U.
� PHONE NUMBER: 53(.0
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MAILING ADDRESS: •U• bU)C. o� ,C.P6 SPO ICCcA V.�C� 1i Z2a
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
YVOODSTOVF1(NSERT :;.<:;;::< x 25.00 =
GAS WATER HEATER x 10.00 =
GAS EQUIPMENT<100,000 BTU(INCL'UDES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS RIDING (EA OUTLET)..... x 1.00 =
BOILER/REFRIG 1-100M BTU x 12.00 =
BOILERIREI=RIG 101 500M;BTU x 20.00 = •
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILER/REt=RIG 1,0001 1 750M BTU x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP &AIR CONDITICNER:O $TONS x 12.00 =
HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
:HEAT PUMP &AIRONDlTIONER>15 3f TONS x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
HEAT PUMP &AIR CONDITIONER:+50 TONS' x 60.00 =
VENTILATING FANS x 10.00 =
..........................................................................................................................................
EVAP,:ORATIVE COOLERS....:.... x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
x 10.00 =
CLOTHES DRYER:::::.:................................................................................... x 10.00 =
............... ................................... . .......... .. ....
...... ....
:..:......:..................................... ::. . ..:..:. .. x 10.00 -
GAS LOG x 10.00 =
MISCELLANEOUS (NOT COVERED ELSEWHERE ` I x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
...........................................................................................................................................
UCINSTED GAS,.APPLIANCE>400,000 ETU., x100,00 -
USED APPLIANCE<400,000 BTU x 50.00 -
USED APPLIANCE>400,000 BTU x100.00
AIR HANDLER <10,000 CFM x 12.00 •
AIR HANDLER>10,000 CSM x 15.00 IN
SUBTOTAL $ l 1.
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$ 3(p.6�
---/L-.-- --t--)Y°(2,5
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675