1989, 12-21 Permit App: 89005303 Gas PipingMECHANICAL PERMIT APPLICATION FORM
Informatjon W ;:..ksheet
JOB STREET ADDRESS: E / F) (f Cr, Lit rl U .
CITY/STATE/ZIP: S.fcori,a.,
OWNER: L. }.
MAILING ADDRESS: F- I r) as C_OA( A
PARCEL NUMBER:
PHONE NUMBER:
(Street)
CONTRACTOR: 1M'Cii &- 1A ) G
MAILING ADDRESS:
(City/State) (Zip)
LICENSE NUMBER: SI ,1 .. to r-) 1 ti f
e. r4.1 ec:.
(Street)
PHONE NUMBER:
Sd* 1,°ti. C11:)11.
(City/Sate) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
DESCRIPTION
= AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PIg,ING (5 OR MORE. EACH:)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS _
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12'
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
PTN. OF HOOD)
MISCELLANEOUS (NOT COVERED
UNLISTED GAS APPLIANCE <400,000
UNLISTED GAS APPLIANCE >400,000
USED APPLIANCE <400,000 BTU
ELSEWHERE)
BTU_
BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
X 35.00 =
x 60.00 =
x 12.00 =
x20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
X100.00 =
x 50.00 =
x100.00 =
x 12.00 =
X 15.00 =
J..6.7
NOTE:
SIGNATURE
MINIM PE T FEE IS $35.00
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
Spokane Coun
1Ar..e.+ f14 12 .l .,
Department ofnBu UV ngaa9nn a ( flQ ARS -' 'W75