1993, 01-08 Permit App: 93000113 Gas Log, PipingMECHANICAL PERMIT APPLICATION FORM -3- f
j I orrm�ation Worksheet 15 3
JOB STREET ADDRES : • / G��' /� V 6L0_12 � q/ .c_o uc
CITY/STATE/ P:, �LC r(L (126. C% G/,2 C' 6' PARCEl1NUMBE .
PHONE NUMBER: 2,;2 / % / V
OWNER: G-ZuL,LirZa tiv
MAILING ADDRESS: .
CONTRACTOR:). ,? /11(
(j
(Street) ,
MAILING ADDRESS'
(City/State) (Zip)
< <
'LI- LICENSE NUMBER: /064-) Atic /&?J
..e7/6g
'7
PHONE NUMBER: ,)`�' 6g 9
LVo
(City/State) (Zip)
DESCRIPTION
(Street)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS; E.QUIPMENT+c100,000 STU .(INCLUDES:
•
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS. PIPING (1 OIT1., ......... ...:.:
BOILER/REFRIG 1-100M BTU
SQILER/REFRIG 1:01$OOM BTU`
BOILER/REFRIG 501-1,000M BTU
SOI ER/REFRIG 10�O03-1',75QM BTU:::.... ....:.
BOILER/REFRIG +1,750M BTU
HEAT PUMR:1& A►IR.CONDITIONER.0-3 TONS: ...: ':.:.....
HEAT PUMP 8i AIR CONDITIONER 3-15 TONS
k EAST PUMP &AIR CONDITION R 1.5 30 MOMS
HEAT PUMP 8 AIR CONDITIONER 30-50 TONS
HEAT PUMP & AIR CONDITIONt R +50 TANS
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
.
CLOTHES DRYER..........::.:...:::>
............................
GAS LOG
MISCELLANEOUS :(NOT COVERED SC SEWHEF
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APP�.IANC 400,000 BTU
USED APPLIANCE <400',.).4,00000,..,.....BTU
;USES? APP .IANC 0 V:::::::><»>
AIR DLER <10,000 CFM
•Allo HANDLER ?•:::,••••• 00 CFM
HAN
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATUR
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 =
x20.00 =
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 =
x 10.00 =
x 50.00 =
x10.00 =
x 10.00 =
xl 000 =
x 10.00 =
x10.00 =
x 50.00 =
X100.00 =
/
11' . l' 0
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$ //. C c)
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ J6•00
Spokane County Division of Buildings
WncI I Qfl Rr��rlu.nu A .,. ... 0....1..... %A/ A nnnt+ n I, ft ss
irt