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1991, 11-18 Permit App: 91007927 Gas Log, PipingMECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: £ / 6,2z-- (,%• (/�e y t/j e. .' CITY/STATEIZIP: Ss/. ket ?9 ii- PARCEL NUMBER: & 5 3 d - /D// OWNER: Ax/ i /- PHONE NUMBER: S3 i _ 20 /1 MAILING ADDRESS: $a&-,. (Street) (City/State) (Zip) CONTRACTOR: /4 'i 6.0-s ,-i-irrcr art- LICENSE NUMBER:A (-,t S$te /00 e/e �' PHONE NUMBER: 922-3 7e' y MAILING ADDRESS: 91 ( /L) /v- AP‘ ,o/CQe� 29 2 06 C�State) (Zip) DESCRIPTION (Street) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) E: GAS WATER HEATER .:......................:......:............:............. GAS EQUIPMEN '«OO,00 BTU (INCLUDES :' GAS EQUIPMENT +100,000 BTU DUCTWORK) BOILER/REFRIG 1-100M BTU B. IL #:•: 1>:.::,;.::::0, .: BOILER/REFRIG 501-1,000M BTU • BOILER/REFRIG +1,750M BTU HEAT PUMP& AIR CONDITIONER 3-15 TONS ::HEA:::::::: ' 'At ; ': <>.....:::.::: ...:.:.. ;..,:. 4�..:.:+.:.::.....:..,. HEAT PUMP & AIR CONDITIONER 30-50 TONS EAS' PUMP AI GONDITIO ER + TONS ......:. VENTILATING FANS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) •{{• yy �.r.( �}�j'-.�i::iEi,`.:}::}ii:::ui.'i::i:iii::�•$:C�::$::isr.':::::•ii::ii::i::?�:'-i!-`v:v:':{:jj:-`:::::-:::Y.i:::v::::: J.v: .....:.v: F:�'TT.......!.5�..:: :.:::ri :•: :::•::::: ::::v.v:.v:::::n} :: {nv:.::v w:: 4•;:.: }.::: �•::::::-'v'.i'.;i??vi: �:::.�::: i:.:. }::'-.., : ... .. DRYER .vn.... n.::::::::::::::::: CLOTHES DRYER GAS -LOG MVSQEL A OUS;(NOTCOVE IED ELSEWIIE# E UNLISTED GAS APPLIANCE <400,000 BTU USED APPLIANCE <400,000 BTU AIR 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 = x 60.00 = x12.00 = x 20.00 = x25.00 = 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 = /Q. cte, SUBTOTAL $ % /,tie PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ 36,•zps Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675