1992, 05-13 Permit App 92003337 Gas HeatingMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JCS STREET .ADDRESS:__ ��3_v_S: _ Cokv/Pr
CITY/STATE _-�«HczC:trr, / Ld-t._ Ffei/ EL NUMBER:
- NE NUMBER:
E. -:.;2 NOF.A
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MECHANICAL WORKSHEETrFEE -EuJLE
1 NUMBER
D=SCRRPT;CN OF UNITS
x 10.00 =
x 25.0C =
(Zip)
:7+-ONE���n:
EL EOTFt1C!DUCT,f,r CF.K (SEPA.FATE
. dOO>rSTOVy'sfsiSF'..-
3AS'+
CAS EQUiF..
GAS
BOILER!REFF..
SOtLERIRE -�
BO:LER17-
H EA r 3 AIR _ � S
?;lrJfP & t,iR COND!Ti:. - ; -ONS
HEAT FUMP. & AiR.CONDITIC: =R +50 : 2';‘.5
VENTIL» .NG FANS
EVAFOi- - ` COOLERS
TYPE i hC ;''ER 12' OR 12' FTP'. OF HOO
-IYPE11.HUOD
CLOTHES DRYEt t
RANGE
GAS LOG
MISCELL AEOL S (NOT COVERED ELSF_WLIERE
UNLISTED GAS APPLIANCE <40C:000 BTU
UL`.►1'STEz t;; F. PF:_-1•?.NNG:G >400,000 BTU
JSED AP°- . - .. 71 000 2 r U
USED APF _
AIR HANG _P C M
AIR HANDLER >10,000 CFiid
X EACH
UNIT
(ZIP)
= AMOUNT
r _ I x12.00 = 2..co
x 15.00
x 1.Ov =
x 12.00 =
x 20-Q0
x 25.00 =
Jx35.00 =
NOTE: MINIMUM PERMIT FEE 1S 335.00
x 60.00 =
x12.00 =
x 20.00 =
x 25.30 =
x 35.00 =
x60.00 =
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 =
x50.00 =
x1 O0.00 =
x 12.00 =
x 15.00 =
/, vv_
S fU BTOTAL
PLL.S: PROCEz EiINdG FEE
'EQUALS: TOTAL PERMIT
FEE DUE
$
25.00
=6�v
SIGNATURE ; /;liju`r�
Spokane County Division of Buildings
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