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1991, 02-28 Permit App: 91000793 Piping
MECHANICAL PERMIT APPLICATION FORM - FInformation Worksheet -. • JOB STREET ADDRESS: £ - / L/6/0 1„J„ej CITY/STATE/ZIP: If A A ' . 02/ PARCEL NER: A OWNER: :. /�.. FHONE NUMBER: `. .��c(—g g l} MAILING ADDRESS: Li (Street r..- (City/State) (Zip) CONTRACTOR: / CENSE NUMBER: (Pl7- PHONE` NUMBER: : MAILING ADDRESS: &-r 7/V %4. " / FfrGV--/ (Street) • (City/Sta e) • (Zip) • MECHANICAL WORKSHEET/FEE.. SCHEDULE NUMBER X EACH , . DESCRIPTIO#J. OF UNITS UNIT. AMOUNT • ELECTRIC DUCTWORK (SEPARATE SYSTEMS) ": x$10.00 WOODSTOVE/INSERT x 25.00 GAS WATER HEATER x 10.00 -= • GAS EQUIPMENT <1000,000 BTU. (INCLUDES x 12.00 •• GAS EQUIPMENT +1000,000 8TU DUCE• ORK) • x 15.'00 '_ ;:' .. -GAS• PIPING• (EA OUTLET), •_ - /: X 1..00 . ••• I)!`� ®-( BOILER/REFRIG 1-.100M BTU x 12.'00 BOILER/REFRIG: 101.500M BTU • -x 20.00 BOILER/REFRIG 501-1,000M BTU _ x 25.00 = BOILER/REFRIG 1,001-1,750M BTU x 35.00 BOILER/REFRIG +1,750M BTU • x 60.00 =. HEAT: PUMP--& :ATR :CONDITIONER, �0-3:.TONS.. ..:. . . . - X 12.00 . : HEAT PUMP & AIR CONDITIONER 3-15 TONS _ x 20.00 HEAT PUMP & AIR' CONDITIONER 15-30 TONS x 25. 00= HEAT`.'PUMP: &!BIR: CONDITIONER -30",450-TONS -..,. . ._ .,. .:r :.:.:.X...:35,.0.0 ,� . :_ :...... ...:,.s._ HEAT PUMP .& AIR CONDITIONER' +50 TONS x 60.00 = VENTILATING.:FANS .. - - X. 10..00 : EVAPORATIVE COOLERS x 10..00 TYPE I HOOD (PER 12 ' 'OR .12' PTN.-.. OF -HOOD) x 50.00 :. TYPE II: HOOD :. . `. _ x 10.00 -... . • CLOTHES DRYER x .10.00 . RANGE , •. . • x 10.00 = • GAS . LOG x .10.00 = 'MISCELLANEOUS NEOUS '(NOT: COVERED .ELSEWHERE)_ X• 10:00- = . - ..2-UN LISTED�t3A8•'APPTJIANCE -:E40O�-0flO BTU- •_ - -. .x..X000.;__, ,.:...:•... .. .._...-,:•.:,.. :...<:-:..:: UNLISTED. GAS: APPLIANCE >400,000 BTUx100.00 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 $ CO . , • PLUS. PROCESSING:,FE. :+.-: $ ,: 25:.00:. EQUALS: TOTAL PERMIT NOTE:_ .�,, I •ERMIT FEE IS $35.00 FEE DUE = $ SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue.Spokane,.WA 99260 (509) .456-3675 . .