HomeMy WebLinkAbout1993, 01-12 Permit App 93000140 Gas LogJOB STREET ADDRESS: /066) `l
MECHANICAL PERM:I APPLICATION FORM
Information Worksheet
E L' '--
CITY/STATE/ZIP: ��'&1 �'�`� PARCEL NUMBER:
OWNER: �� PHONE NUMBER:
MAILING ADDRESS:
CONTRACTOR: AlT7t% ,/
c):3 - C
9 Y -
(Street)
e9/1 1.)/.7
(City/State)
LICENSE NUMBER:
PHONE NUMBER:
(Zip)
% 7 ; /-0J/
MAILING ADDRESS: �� g7b 20-.7 20/
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
.................................................
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 3-15 TONS
•
HEAT PUMP & AIR CONDITIONER 30-50 TONS
•
::::::.:...........................................................:.:..
VENTILATING FANS
•
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
FANG ..; :n •. ... .
GAS LOG
M , ;C • l4: EOUS ::,;:OT CO E EI EI E1l H
UNLISTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
t<i:i+a+�r� �s?'r�irti�ii?a�tr�•e'i'i+'r«::,_;::��rti�r!�?<n'nn�:�rili�!iipi
AIR HANDLER <10,000 CFM
>4I.R
►'LEI���1 t�fl0:0;
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE (1-/``----) V(
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
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 =
x35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x10.00 =
x 10.00 =
x 10.00 =
x10.00 =
x 10.00 =
x 50.00 =
9, -
i.
/
/07-
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$ 9i,
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
-> .
= $ i
6Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675