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1992, 05-14 Permit App: 92003411 Gas Log, Piping MECHANICAL PERWIT'APPLICATION FORM inforth pn Worksheet JOB STREET ADDRESS: X20/ c� ( '° ?2 6 CITY/STATE/ZIP: < PARCEL NUMBER: OWNER: 1' s ��i�fi► PHONE NUMBER: MAILING ADDRESS: (Street),/ (City/State) (Zip) CONTRACTOR:/1-(41 5 SG^Pt -r'. ))4- 'I, LICENSE NUMBER(I1 SSS /C-91D 'K PHONE NUMBER: 1z2- 370 Cr MAILING ADDRESS: St ( k/ f G' v� _5a/ h 7 20C (Street) (City/State) - (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = x 25.00 = GAS WATER HEATER x 10.00 = GAS EQUIPMENT«OO, t B 'U INCLUDE$ .'.: x 12.00 = GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = I , 0� x 1.00 = BOILER/REFRIG 1-100M BTU x 12.00 = BOILER/R I=RIG 1 1- 0M.BTU .. x 20.00 = BOILER/REFRIG 501-1,000M BTU x 25.00 = BOILEI IREFRIS 1,0001 1,750M BT I; >:::» x 35.00 = BOILER/REFRIG +1,750M BTU x 60.00 = HEAT PUMP&AIR CONDITIONER 0 3 TONS :.... x 12.00 = HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 = NEAT PUMP AIR ONDITIC NER 15 30 TONS <, >: ' . x 25.00 = HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 = HEAT PUMP&AIR CONDITIONER+50 TON$ ;::.>`:`;::' x 60.00 = VENTILATING FANS x 10.00 = x 10.00 = :.;:.;:.;:.:::.:::..:::.......................::....................::....... . . . . .. .. . . . . . .. . .. ............ TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 = x 10.00 = CLOTHES DRYER x 10.00 = RANGE .. .: x 10.00 = GAS LOG / x 10.00 = MISCELLANEC US(NOT COVERED ELSEWHERI= x 10.00 = UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = ULINSTED GAS APPLIANCE>400,000 BTU"'' :.. 'i'iw x100.00 = USED APPLIANCE<400,000 BTU x 50.00 = USED API LIANCE>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 Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675