1992, 08-28 Permit App: 92006949 Gas MeterMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: E/o 3 oZ %e°x'!,f✓f' '
CITY/STATE/ZIP: 5;74&1"7"4- 4% 5P"‘PARCEL NUMBER:
OWNER: �� f't' ��/45 PHONE NUMBER: f2G �755-
MAILING ADDRESS: Sri -AAA -
CONTRACTOR:
,/ (Street) (City/State) gip)
/t'//� LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
.... :
BOILER/REFRIG 501-1,000M BTU
:
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 3-15 TONS
t:•:i1MiaMfik• • •
i::isMci:Rif.F::i::1I.M#:�!P!r'i:.�l;::f
:::: :::.� •: •::.: �::::: ::::::� ...v• ..... • •::::: ..:......:. �: .: •:: •: :::. �. -. :::::::::n Win::.
HEAT PUMP & AIR CONDITIONER 30-50-TONS:-
VENTILATING
0-50 TONS
t'1 M.+.`Y:�:.�:/1f::Y►:"tM::::if:::3:twt::iia:iM�:ti�`iiii�;ir:'r::i riiiw::}::::!�:y;tr14:4: �r'c:;•::::a>:
VENTILATING FANS
TYPE I HOOD (PER 12OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
UNLISTED GAS APPLIANCE <400,000 BTU
::t::� c:>t►tae�yrr..w ::r.:�:�.s>srtwt:::t>Y>� i:� :x:x:x
USED APPLIANCE <400,000 BTU
>r=r>*>i
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
2�{0
SIGNATURE_
VT
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =-
x
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 =
SUBTOTAL
$
PLUS: PROCESSING FEE •
+ $ 25.00
=^UALS: TOTAL PERMIT
FEE DUE
= $
rision of Buildings
es ' : roa • way venue po ane, WA 99260 (509) 456-3675