1992, 12-07 Permit App: 92010727 Gas Log, Piping MECHANICAL PERMIT APPLICATION FORM l 2 7 2
� Inforrrf Worksheet
JOB STREET ADDRESS: t L S 1 7 /54
CITY/STATE/ZIP: O/( _ PARCEL NUMBER: ...33 c 3 �. 1 D DC
OWNER: "( t.r. HEES0t) PHONE NUMBER: 61,13
MAILING ADDRESS:
1 C0 ' 3 1eet) ` (City/State) (Zip)
CONTRACTOR: S I1 LC LICENSE NUMBER: 41A-S5e1G6/Lk
PHONE NUMBER: (o c)/.5
MAILING ADDRESS: ( ) P.-(1 /C 'pa f<'ci.t - 6 s S y g
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
N
x25.00 =
GAS WATER HEATER x 10.00 =
GAS EQUIPMENT<10 , t BTU INCLUDES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
00 =.1
GAS
x PIPING(Els►OU:::::.:�'I'�..::.::.;::.;:.;:.,.;::::. .::.;::.;:.;:.::.;:::. _:: � 1,a(
BOILER/REFRIG 1-100M BTU x 12.00 =
20
x 00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILER/REI=RIG 1,0001 1,750M RTU `::>>::. 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 =
HAAT PUMP&AIR CONDITIONEl 15 30 TONS x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
HEAT PUMP&AIR CONDITIONED+50 TONS x 60.00 =
VENTILATING FANS x 10.00 =
x1
10.00 =
. ............ . .............. . . .............
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
y1 _
x 0.00
CLOTHES DRYER x 10.00 =
• x 0
1 00 =
GAS LOG j x 10.00 = -Ob
MISCELLANEO (NOT Cr VER D ELSEIAIHER>=%:::> x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTED GAS APPLIANCE 400 (00 BTU x100.00 =
USED APPLIANCE<400,000 BTU x 50.00 =
x100.00 =
AIR HANDLER<10,000 CFM x 12.00 =
x 15.00 =
SUBTOTAL $
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$ * (r) ,CSO
SIGNATU RE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675