1991, 11-25 Permit App: 91008171 Gas Log, PipingMECHANICAL PERMIT APPLICATION FORM V -L-Afc
Information Worksheet �„ C 0 e <
JOB STREET ADDRESS:_ ,9 S� c e' �6f'hQJ . p / ,-1 d . 1 1 j 6
CITY/STAT ZIP: 'J
' / PARCEL NUMBER: I �64- b i
� � '!
OWNER:1 RR F(J 1 t1 1✓A PHONE NUMBER: gsr7 i45Cr,c2-
MAILING ADDRESS: ,,zo ' (1i7K216-6 �� pQ,a,.
(Street) (City/State) (Zip)
CONTRACTOR: ,5c l ~--- LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Zip)
DESCRIPTION
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/IN:SERT
GAS WATER HEATER
GAS EQUIPMENT <10.0.,000 B;TU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (BA OUTLET)
BOILER/REFRIG 1-100M BTU
BOILI /REFRIG_ 101-500M BTU
BOILER/REFRIG 501-1,000M BTU
I OIL R/RBFRIC 1 F0001 1,750M BTU
BOILER/REFRIG +1,750M BTU
HBAT PUMP &AIR CONDITIONER 0. 3 TANS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT P MP &AIRCONDITIONER 1;5 30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
NDITIONER +50 TONS
H'E
VENTILATING FANS
EVAPO ATI COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
...........................................
CLOTHES DRYER
GAS LOG
MISCELLANEOUS (NOT COVERED` ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTEDGAS APPLIANCE>400,000 BTU •
USED APPLIANCE <400,000 BTU
..................................................................................................................... .
.................................................................................................:...:.............. .
USED APPLIANCE >400.,000 BTU
AIR HANDLER <10,000 CFM
AIt HANDLER>10,000 CFM ,
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
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 =
x35.00 =
x60.00 =
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 =
x50.00 =
x100.00 =
x 12.00 =
x 15.00 =
f
•
I
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_ $
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675