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1991, 02-06 Permit App: 91000406 Gas Log, Piping • MECHANICAL PERMIT APPLICATION FORM . Z----- -9 Information Worksheet e/-Y0<, JOB STREET ADDRESS: G ,(_.-Y_) -, / ' 1 . ;2 5 - T O('/Y CITY/STATE/ZIP:S,e k&,.,c L . `rL1 ZPARCEL NUMBER: z . " OWNER: V� euc f-tci•u< PHONE NUMBER: _ MAILING ADDRESS: E � L /& �'� �pe.> (Street) (City/State) . (Zip) CONTRACTOR: /,q i,- g- ,- e� _ LICENSE NUMBER: �.� r," (Z I 0- =. .`•• Y y PHONE NUMBER: („5-3.‘i) /7 3 7 , MAILING ADDRESS: /22.5- //.? /6/'d JCA ct?Z.Z6 (Street) (City/State) (Zip) . • MECHANICAL WORKSHEET/FEE SCHEDULE . • '. fi,,...,,•: NUMBER X EACH . • : . DESCRIPTION OF UNITS .: UNIT- =s AMOUNT..:;. ' DUCTWORK• SYSTEM . .X$10.00 ,'_ '.''' ''• . •WOODSTOVE/INSERT • X, 25 ,.00 _ 3.4,i. 1. GAS .WATER R .HEATER A HEATING `EQUIPMENT <100,000 BTU - :'' — X'12'' 00 n ; a,4:;, - ,.,*,.. HEATING-EQUIPMENT +100,000 BTU .;.. X 15.00 �= k.1 ; :':• -r A,,l� •,' 1 .' ; :GAS PIPING::.(EA OUTLET) - - - • • x .1.00 = a ;iii+,t.� P,�::.•. , .r t�;REFRIG. 1=100M BTU (NOT.,A/C .OR HEAT: PUMP),,', • 'x•.12..00 `_ � 0tit ' 0, ry,,,, , ...f.'.ii, ;R REFRIG',101 500M..BTO- _ ,.. H'''.';rte : , Y y X:,-213: ..00 4" s,,� ,x• , REFRIG; 501 -1,000M;BTU .,:,'4.:,,;:;,:!-: :. <t;, . • x 25.09 = ry. ,R, ';.1'.k'''.'.'4.;:;•• Y REFRIG. 1. 001-1. 75014 BTU_ `7!;',.:';';':0',..; • x. 5 '0� _' +4 v,'s , `f.. REFRIGa+1 7501 BTU s N' _ / :��'� ....' � � `h� l+ ! h"�4..h) Ysc t' x,',.‘,60.•00..,'1,, , �'k'SdnyK td J;7 I};-f�i ',. �. `.{�.. f7HEAT ;PUMP• &' AIR3,_CONDITIONER'�0 w3,.:,TONS;ris i i.,,. . ,(1 +, •4r- 'a,." X Y12::'00 ; ��'ti�;.'•s� .f.,e:>>*.�� .. ��Ye;�.,. ��HEAT:.PUMP;,&,1'AIR-CONDITIONER.3 15"w! ONS,,, ,�,',' •�,,,.44 if;1ti., , ,:f•t x2000Nws $1,0M0141,04,..:::- .,„,.tix; :, ,'ay " '''..'.'#,,, r SHEAT 'PUMP,'& ,AIR CONDITIONER '15-,301-':;TONS ',; ' �' X: 25'.'00 �' '#�;�'44?" r""4•1-'• °,�.,�c ,,, HEAT PUMP & ;AIR' CONDITIONER 30 50;TONS r * •,-�..,�.�.t.' x•',35:;00' _; # r:'4"3++..,s *' , ',' 4 2. :'� HEAT` PUMP & AIR. CONDITIONER +50.,,TONS X 60`.00 :=s ) VENTILATING' FANS x 10.00 = u: .':EVAPORATIVE COOLERS X 10.00 ._ TYPE I:.HOOD (PER 12' OR 12' PTN. OF'. HOOD) ' x 50.00 =, TYPE II HOOD X: 10.00 sz . CLOTHES DRYER • x 10.00 = . . RANGE" x 10.00 = GAS LOG r x 10.00 = • fi, c 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 ss q - ' - • • SUBTOTAL . $ /, 'acs PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT • NOTE: MIN'IM`UM PE T FEE IS $35.00 FEE DUE _ $ 6_ �u SIGNATURE / ? . Spokane County Department of Building and Safetyt West 1303 Broadway Avenue Spokane_ WA 9 26a 15 qt stir..1r is