1992, 11-19 Permit App: 92010224 Gas Piping MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: /21 f(SZ •=- 6 .e/C-PJ (f?-
CITY/STATE/Z : a A .1 & CAP 9ei,C PARCEL NUMBER:
OWNER: L-,1:41;1-e7 (./111yj PHONE NUMBER: P-2. 7- S24 MAILING ADDRESS:
ADDRESS:
(Street) (City/State) (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 =
WOODSTOVEiINSERT x 25.00 =
GAS WATER HEATER x 10.00 =
GAS EQUIPMENT x 1200. =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING (EA OUTLET) /./ x 1.00 = 1/ CC
BOILER/REFRIG 1-100M BTU x 12.00 =
iMOIMENVIIMOMMENSSINIMIK x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
0ajggageggailNaigtmotormemominglon x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
i;Reniiesme$KAtOZOMIONEROAngtonninin x 1200. =
HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
iiHgagigeii!ol:Agootionvogyilogonjwasism x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
mmegotaNwagatmatmoononsom x 60.00 =
VENTILATING FANS x 10.00 =
iigogosangPMBAIRINow./ x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
neig MagegigninentatEMENIMEN x1000 =
CLOTHES DRYER x10.00 =
RANGE• •„,• ••
x 10.00 =
GAS LOG x 10.00 =
MO.POPPANPOINpf x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
iigtOgliggi1116$1iAPPLIANCE RNORMIIIMMI x100.00 =
USED APPLIANCE<400,000 BTU x 50.00 =
USED APPLIANCE>40Q000 BTU x100.00 =
AIR HANDLER <10,000 CFM x 12.00 =
.#01*N014E:R!*100010FMNIIIIIINEMElin x 15.00 =
SUBTOTAL
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675