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1990, 09-26 Permit App: 90004927 Gas Log MECHANICAL. PERMIT APPLICATION FORM Inforwation Worksheet JOB STREET ADDRESS: E, 4.3'4/a / a 1� CITY/STATE/ZIP: W�T 9 9PARCEL NUMBER: t - (J / OWNER: 4..e. . PHONE NUMBER: ?a 7`--./76, / MAILING ADDRESS: _ (Street) (City/State) (Zip) CONTRACTOR: LICENSE NUMBER: /9/119/LAA/Z--/934/./ PHONE NUMBER: 9 c U-a I0 0 MAILING ADDRESS: (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT = AMOUNT DUCTWORK SYSTEM x$10. 00 = WOODSTOVE/INSERT x 25. 00 = GAS WATER HEATER x 10. 00 = HEATING EQUIPMENT <100, 000 BTU x 12. 00 = HEATING EQUIPMENT +100, 000 BTU x 15. 00 = GAS PIPING (EA OUTLET) x 1. 00 = REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12 . 00 = REFRIG 101-500M BTU x 20.00 = REFRIG 501-1, 000M BTU x 25. 00 = REFRIG 1, 001-1,750M BTU x 35. 00 = 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 = HEAT PUMP & AIR CONDITIONER 15-30 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 = 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 = /0. MISCELLANEOUS (NOT COVERED ELSEWHERE)_ _ x 10. 00 = UNLISTED GAS APPLIANCE <400, 000 BTU_ _ _ x 50. 00 = UNLISTED 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 $ /D. 0 PLUS: PROCESSING FEE + $ 25. 00 EQUALS: TOTAL PERMIT NOTE: MI .. M/M PERM �.EE IS $35.00 FEE DUE = $ 35, 00 SIGNATURE 00 i Spokane County Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675