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1992, 12-10 Permit App: 92010818 Gas Log
MECHANICAL PERMIT APPLICATION FORM : :- ' Information Worksheetf1 \- � JOB STREET ADDRESS: : ..,1 ''<-; .i. kit I+ 0 5 Lt) 1 bis re, KA CITY/STATE/ZIP: J/)CJ kCr�. ti,l/ ?9 O( PARCEL NUMBER: OWNER NC-i .�FL in , Jr o_,:ketiriC((f€ Pd NUMBER: MAILING ADDRESS: t R i -4--U 5 Li) t I b 1_(4.. KGQ 5 �Kc-21-,,.e.; 4t,d .9(?e9,0 67 (Street) (City/State) (Zip) CONTRACTOR: .. , ,- • ,. - . - , ,LICENSE NUMBER: BANNEFF378NT CONTACT: RUSS LUNDE PHONE NUMBER: 535-1711 MAILING ADDRESS: P.O. Box 4346 Spokane, WA. 99202 , (Street) (City/State) (Zip) : MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT AMOUNT • ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = , :;. ., WOODSTbVE/ INEER'T, , .2x > . x 25.00 =. :. ,.,.,. .,,._ GAS WATER HEATER x 10.00 GAS EQUIPMENT<10000O DII) NC;LUDES X12.00 = :. GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = GAS PIPING (EA OUTLET) it x 1.00 = BOILER/REFRIG 1-100M BTU x 12.00 EOILER/REFAIG 101-$OOM'g t)L x :'N ' '; = ,. ..,... ..,. T .�,"x ::. ...... x 20.00 ..,:-:',;:::•,,,,:4-1.., BOILER/REFRIG 501-i,000M BTI.,i' x 25.00 _ BOILER)REFRIG' 1,0001 1,750METU t, x =35.00 .,,„4..,.;:..4-- ..., ,,;,44,:,-,',;.-,,i,,. ` BOILER/REFRIG +1,750M BTU ,•,, x 50.00 HEAT PUMP &biR CONDITIONER 6.43 TONS X12.00 = , . HEAT PUMP &AIR CONDITIONER$ 15 TONS x 20.00 = HA'..t PUMP &AIR CONDITIONER I5 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 = .. „rs EVAPORATIVE COOLERS t x 10.00 = . ,. TYPE I HOOD (PER 12' OR 12' PTN OF HOOD) x 50.00 = :'' .. f; TYPE II HfiOb . ... ::::>;>:<::<:}:' ,...::.. .........::: . ...,. . �::::::,;,:.:»:... : ,: x 10.00 v ,. CLOTHES DRYER x 10.00 = . RANGE } , x 10.00 = GAS LOG I x10.00 = 1.0. c7 MISCELLANEOUS(N(j1bOVEIREO' LSEWHERE x 10.00 = UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = ULINSTEdGAS APPLIAROE>400,b00 BTU.. . . x100.00= USED APPLIANCE<400,000 BTU '" ' x 50.00 = USED APPLIANCE>4004000 BTIJ 4 h :i x100.00= AIR HANDLER<10,000 CFM x 12.00 = AIR HANDLER'>10,000 Ct'M <,.....Y n` .. x 15.00 = -"--'-';'-•:-.4),V'',',-...1-:'.. SUBTOTAL $ I'003 fir; ' PLUS: PROCESSING FEE : +$ .; .25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT FEE DUE _$ : ,;gyp 6 • SIGNATURE -,: )-i.. 6 ...,. ,i.,.,j .. . ,........- . .. ...:' . ...-.... ... - -.,;,' 4 Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA' 99260 (509) 456 3675.