1992, 03-11 Permit App: 92001453 Gas Log, Piping' MECHANICAL PERMIt APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: - % / 2
PARCEL NUMBER: �/-I,"-'` 16
PHONE NUMBER: 9,2f- o'/6
r
-
CITY/STATE/ZIP:. 04 6/.)-A
OWNER: D/9 C.- E ,e /2)/-) 5 0
MAILING ADDRESS: C "39i y ,3oori< 'e k A "le / GU.d J.`' /.4
(Street) (Ci /State) (Zip)
CONTRACTOR: ES ro nl Cc /-i i ivg. 2 LICENSE NUMBER: 6-5-3 /
4, 14,_ r f.2 7 P E . :tiFc.2��
/, / PHONE NUMBER: 4/ 7
MAILING ADDRESS: A ' s3,26' 6e»» /€f, e2 A2A, �
(Street) (City/State)
MECHANICAL WORK
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
D T : V .IN
GAS WATERHEATER
At,.1PM NT <i00 BTU: NCLUDES.
GAS EQUIPMENT +100,000 BTU DUCTWORK)
A: ...IPI•
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
•T3C>..(.LERIR RIG;:1: 0 01.;-1 x7.50M
BOILER/REFRIG +1,750M BTU
HSAT UMP &'AiR ORION'
..............:..........::........:......... ...........::.::..
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT I UMP & AIR N I It NER 15:-3.�D; TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT UM `AIR CONDITIONER>+50•TONS<
VENTILATING FANS
VAP RATIV•
E:::::.
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
RAN 1=<;><<:> '><<>< s >>><»:»>'_:>;
GAS LOG
MI CELLAN.rrOUS NOT CO ERE ELS NIH :1
:::::.::::..:....:.:...:::...::..:..::..:...:.....::..:...::.......:.......:.....
UNLISTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
USED:ApPLANCE00:iOQ0.;;:::;::.;..:;;.;::.;:.::.;;:.>;;.;;;:.:;.::.:::.;;;;:
AIR HANDLER <10,000 CFM
AIII. WANDLaR . a•.,QQQ<G,:;;:.:;.::..::::;;;
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATUR
/l/
(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 =
x 35.00 =
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 =
x 10.00 =
x 10.00 =
x10.00 =
x 10.00 =
X 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
I
x 12.00 =
x 15.00 =
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675