1991, 10-09 Permit App: 91006713 Gas Log, Piping 6.3 -
MECHANICAL PERMIT I PPLICATION FORM
Informa�,tion '= orksheet "J' 'm-� a
JOB STREET ADDRESS: /)/ADD 7,5 !% /bid`-l C/ D ,/ e
CITY/STATE/ZIP: 5 f&-a
� (.0 g'.5ia06 PARCEL NUMBER: 0165'3 - oi7�6
OWNER: .I71 SAP D r/` �� PHOPiE NUMBER:
MAILING ADDRESS: /goc27 A
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
x 25.00 =
GAS WATER HEATER x 10.00 =
GAS:EQUIPMENT 100,# 0 BTU(INCLUDES ":%' x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
x 1.00 =
BOILER/REFRIG 1-100M BTU x 12.00 =
1LE
x 20.00 -
BOILER/REFRIG 501-1,000M BTU x 25.00 =
B. :
x 35.00 =
-
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP&AIR CONDITIO tER 0-S TO ts_:> >:> <; ;' x 12.00 =
HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 =
HEATPUMP I AIR ONDITIONER 15.3.......-:>TON ......>::,:.;::: ::.:. x 25.00 =
HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 =
...iiHigorpm.RwAtft CONDITIONER oolvNS x 60.00 =
VENTILATING FANS x 10.00 =
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 g> :;;' x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
UL NSTED+G 1S PPLIAN+ 400,t ' . x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
US. oANGE : 0.20Tll :>::>::....... x100.00=
AIR HANDLER<10,000 CFM x 12.00 =
x 15.00 =
SUBTOTAL $
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675