1993, 06-21 Permit App: 93004890 Gas Log, Piping 7)0(g* V21xr1 k
MECHANICAL PERMIT APPLICATION FORM - I lo L - Ii6
Information Worksheet
JOB STREET ADDRESS: E )1--/ 5 k I S 610
crryisTATEizip: \/ -e_Aokektk ,0 a_ g 03,7 PARCEL NUMBER: 1452-3 LP, /5/
OWNER: L e_AA VovSvn PHONE NUMBER: 6t FS33
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: IJ C &14j o C FJJfIZ LICENSE NUMBER: r(-+ b
PHONE NUMBER: ( (3) 6;01_0 /
MAILING ADDRESS: E 3J [)1ó3i'1L(( )n:(,1,-„; C1ei 2
(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<100,000 BTU(INCLUDES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
AS PIPING(EA OUTLET) x 1.00 = 1 OD
BOILER/REFRIG 1-100M BTU x 12.00 =
BOjt1.4-P4Riggi5#0.ii:f0f;500Milit.MIES-ERIMifiggigna x 20.00 =
BOILER/REFRIG 501-1,000M BTU ------ - x 25.00 = - • • -
8O1I.Efli1EFfl1G I,0001-1,750M 8Th x 35.00 =
BOILER/REFRIG+1,750M BTU x 60.00 =
hEAT PUMP&AIR CONDITIONEJI 0-3 TONS
x 1200. =. -
HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
H EAPPUM PWAIRCONDITION ER 15-30 TONS
x 25.00 =
HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 = .
HEAT PUMP &AIR CONDITIONEP +50 TONS x 60.00 =
VENTILATING FANS x 10.00 =
.;.rtyApoRA:Tslygp%g95mggi.giirgigl-gifiggomfigig6siimi:-E x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) - - x 50.00 =
x 10.00 =
CLOTHES DRYER • x10.00 =
RANGE x 10.00 =
GAS LOG 1 x 10.00 = /0- Do
MISCELLANEOUS(NOT COVERED ELSEWHERE x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
U1.....IN.STED:IGAS-AFT4Aocg: qq;pcpipTvgiiigfiiiimoigo xio0.00=
USED APPLIANCE<400,000 BTU x 50.00 =
USED APPLIANCE>400,000 BTIJ - x100.00=
AIR HANDLER<10,000 CFM x 12.00 =
AIR:HANDLE .:.„ x 15.00 =
SUBTOTAL S I 1-00
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT oo
FEE DUE = 3(0 -
SIGNATURE
Spokane County Division of Buildings