1992, 09-25 Permit App 92008045 Gas Log-Voidf
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
,/QB STREE1 ADDRESS._ _12.1_22.,52
CITY/STAT UZI P: OprorTl) A))7-1/ u-)/9.
OWNER: a fi-T/i/ I VI)
MAILING ADDRESS:/9 '-
(Street)
CONTRACTOR; /06 RTA tvlsr n 77 Al
MAILING ADDRIS‘P-O. BO X /3 1./4'7
(Street)
/6R61U.Y)14
?...??.L.L PARCEL NUMBER:
PHONE NUMBER:
(City/State) (Zip)
AweLICENSE NUMBER: MuREF-71g,g2L-Tri
PHONE NUMBER:
efi ioe L....1t)
(CltylState) (Ztp)
MECHANICAL WORKSH.EET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNI1
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INs5ERT•:.::.
GAS WATER HEATER
GAS (.100,000,$T0 0140.00s :
CAS EQUIPMENT 4-100,000 BTU DUCTWORK)
GAS .AiPiN(EA.OUTLE1)H.:
BOILER/REFRIG 1-100M BTU
$01LERIREFAZ 1 0-14:500M:BTU:„ :..-
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
HEATOLIMP,AfAin CONPJTIONE14-.043 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEATO.UMp&:-AIR cONDITIPNE.RI:30tONS:s,
HEAT PUMP & AR CONDITIONER 30-50 TONS
HEAT PVMP.8 AIR.CONDITIONER TONS
VENTILATING FANS
EVAPORATIVECOOLERS .•...
TYPE I HOOD (PER 12' OR 12' PTN, OF HOOD)
TYPE)114006;',.
. •
CLOTHES DRYER
:
GAS LOG
misptaAti449va-sr46T..COVEJFie.0, p4040-f,R
UNLISTED GAS APPLIANCE <400,000 BTU
ULIO.STPAa.APPLIANCE.4(4,o0o BTU:
USED APPLIANCE <400,000 BTU
tJSEDIPKIANCE$400991-p-t0..•
AIR HANDLER <10,000 CFM
A.IR'HANDLERi> 1 o;ocio CFM• .
NOTE: MINIMUM PERMIT FEE IS $35.00
. •
•
x 10.00 4B
x 25.00
x 10.00
x 12.00
x 15.00 at
x 1.00
x 12.00 -
x 20.00 wr
x 25.00 =
x 35-00
x 60.00 =
x 12.0G =
x 20.00 -
x 25.00x =
: 6350.0°0°
x 10.00 =
x 10.00 =
x 15°100°°
x0
x 10.00
x 10.00 =
x 10.00 =
x 10.00 la
x 50.00 =
x100.00 =
x 50.00 =
x100.00
x 12.00 =
x 15.00
SUBTOTAL
PLUS: PROCESSING FEE
EQUALS: Tout_ PERMIT
FEE DUE
= AMOUNT
$ oti
$ 25.00
30
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 45t3-3675