1990, 04-11 Permit App 90001391 Reconnect Gas PipingJOB STREET ADDRESS:
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
S. 221 McDonald Rd.
CITY/STATE/ZIP: Spokane, Wa- 0921E
OWNER: Vern Milholland
. 8712 -fission Spokane, Wa. 99212
MAILING ADDRESS: (Street) (City/State) (Zip)
CONTRACTOR: Norco Heating & Air Cond. Inc.LICENSE NUMBER: NORCOHA17ORZ
PHONE NUMBER: 534-4975
MAILING ADDRESS: -5;, 5051 Trent Spokane, Wa.- 99212
(City/State) (Zip)
PARCEL NUMBER:
(Street)
PHONE NUMBER: 926-6435
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER I X EACH
DESCRIPTION OF UNITS UNIT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (EA OUTLET)
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
AIR CONDITIONER 0-3 TONS _ _
AIR CONDITIONER 3-15 TONS _
AIR CONDITIONER 15-30 TONS _
AIR CONDITIONER 30-50 TONS _
AIR CONDITIONER +50 TONS _ _
FANS
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)_ _
UNLISTED GAS APPLIANCE <400,000 BTU_
UNLISTED GAS APPLIANCE >400,000 BTU_ _ _
USED APPLIANCE <400,000 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 12.00 =
X 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.0C =
x 20.00 =
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 =
= AMOUNT
10.00
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
PLUS: PROCESSING FEE
EQUALS: TOTAL PERMIT
FEE DUE
10.00
+ $ 25.00
35.00
Spokane County Department of Building_and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675