1992, 12-04 Permit App: 92010676 Gas Log, Piping'MCHANtCAL PERMtT M'LiCA11ON FORM
'ntormatlon Work*hoot
•( ti.
JOB STREET ADDRESS ki it€ 1 j 4&.4 JL
CTYlSTAT/ZlP:.d.
OWNEfl:.'.,
MAILING ADDRESS:
treet)
CONTRACTOR: /7L /\,
PARCEL NUMBER:
PHONE NUMBER:
iin
:.
LICENSENUMBER:/9JX 7,PZ/// J
PHONENUMBEft
MAflJNGADDRESS: l '2cf /947Y7frt?1y &/1'(Jf 72
(Street) . (City/State) (ZiP)
ECt-IANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION
ELECTRIC/DUCTWORK
GAS WATER HEATER
OF UNITS UNIT
GAS EQUIPMENT +100,000 bTU bUCTWObK)
GA s4k &J?L�Yc iii
BOILERIRFRIG 1-I00M BTU' ""I%
ROlLER/RR1G 501--1,000M BTU.
tOIRJflFRIG +1 ,750M
.................... »4.. .................
HEAT PUMP & AIR CONDITIONED 3-15 TONS
HEAT PUMP & AIR CoNDITlON 30-50 TON
VENTILA1ING FANS
TYPE 1 HOOD (PER 12' 0R12' PTN. OF H000)
TYP 11 t4&d
CLOTHS DRYER
GAS LOG
MISCELtSNEOUS (NOT
UNLISTED GAS APPLIANCk400,000 BTU
UUNf.6 APPLIAN k �5,�00 TU
USED AfPUANCE X400,000 STU'
USED AUMi 81JJ
AIR HANDLER <10,000 CIM
AIR t-At4o1fl >10,000
OUNT
xlO.00 .:
x25.00it
x 10.00 .''
x 12.0O
,I 1.00
x 12.00
x 20.�0
x 25,00 •»; '...
35.00 . .
x60.00 '
x12.00
x20.00
x25,OO..M) •.
x 1.
X60OOk,' .
x50.0�e'; -
x10.00+ .:
x 10.00
X 10.00 m..; .
xio.00.;
x10.O0.'!
k So.o.
x100.O0r :
x50.00
xlOO.00 -;
x12.00 *1:
x15
A0 e
, ,,
NOTE: MINIMUM PERM
SIGNATURE
;,
K EIS $35.00
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
'