1991, 08-29 Permit App: 91005417 Gas Log, Piping MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: / ?1 Z (7 Z>gI/o,1,I 21;
CITY/STATE/ZIP: • -��L `'L., . PARCEL NUABER: /S/5'-/Y /SD 7
OWNER: s. . _. ��/ _ PHONE NUMBER: 7aa- GS.? 2
MAILING ADDRESS: / i 7 1, 4"'
(Street) (f ty/S : e) (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 =
W QD =
QO. .STOVEtiNSEi�T.::<::< ; ::::�:�::: >:>:`;::::><.>:>::;:< '„;::',<.:::>:::::::::;:__.:.<:.`: 2 _
-:: :.;.;;;;:.;:.:. ;::._.:_;;;>;;:; :;>;;;;;:: ;:.;:.; ;:.;;:;:::-;;;:.;;;:: x 5.00
GAS WATER HEATER x 10.00 =
GAS EQUIPMENT<100(i0 BTU(INCLUDES.:'.:<::::> :: x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS€PIPING(EA QUTLE"fj: >: l x 1.00 =
BOILER/REFRIG 1-100M BTU x 12.00 =
iRP1_ II 3EE1 #q 84.00 gTU:;::;»::>::>:::::>::;:::>:..:;::::.>::>::>::::>::: .. ... x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
0..... #Y/REI=.IG : 00M
. M BTS x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP&AIR CONDITIONER I $"1`ONS '.:>::>:>> x 12.00 =
HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 =
HEAT'PUMP&AIR WNDITIONER15-30:TONS x 25.00 =
HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 =
HEAT PUMP&AIR CONDITIONER+50 TONS:.;;'::>: x 60.00 =
VENTILATING FANS x 10.00 =
EV. =
AP RA's V .
............ � . 5�::::.;:.::::;.:.:;:;: :>::><;.::-::.::.;:;:>;;:>:>;::.::;:.;:.;:.;;:.;;:.;:;.;:.;:.;:-;:-:;. x 10.00
TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD) x 50.00 =
TYRE II HOOD x 10.00 =
CLOTHES DRYER x 10.00 =
RANGE x 10.00 =
GAS LOG l x 10.00 =
MISCELLANEOUS(NOT:COVERED ELSEWHERE x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTED GAS APPLIANCE>400,000 BTU x100.00 =
USED APPLIANCE<400,000 BTU x 50.00 =
USED APPLIANCE>400 000 BTU x100.00 =
AIR HANDLER<10,000 CFM x 12.00 =
AIR HANDLER>10,000;CFM x 15.00 =
SUBTOTAL $
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =
SIGNATURE 'a / �I / �'�� --
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675