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1991, 10-22 Permit App: 91007073 Furnace, PipingMECHANICAL PERMIT APPLICATION FORM Informat'•i24,Wer (sheet STREET ADDRESS : / � �1' r 4/- 674 STATE/ZIP: A1 PARCEL NUMBER: PHONE NUMBER: ILING ADDRES": TRACTOR: ,(Street) u LINGO ADDRESS :gig 3x: . (Str.e M: (City/State) (Zip) LICENSE NUMBER: PHONE NUMBER: es#view State HANICAL,,WORKSHEET/FEE.SCH NUMBER," DESCRIPTION OF UNITS X,r'EACH ;:tjNIT = AMOUNT WORK SYSTEM_ STOVE/INSERT,_ MATER HEATER ING. EQUIPMENT <1004000,;.BTU ING EQUIPMENT 4-109,T000BTU 4$.IPING (EA. OUTLET) _ FRIG100M BTU '(NOTA/C,.OR HEAT PUMP) FRIG.;101-500M;' BTU' .,.•: ' _ '• F x.9 501-1, OOOM BTU' _•..,. . - -: - - I I, 001-1, 750M: BT,U` ZGa+1�750M BTU, ! __,: • UMP'.& AIR.CONDITIONER 0-3'TONS._ _ PUMP & AIR, CONDITIONER 3-15..TONS,._ ,UMP &. AIR . CONDITIONER 15-301TONS • T jPUMP & AIR' CONDITIONER 30-50:TONS _ LATING FANS EAT <PUMP & AIR. ?CONDITIONER +50. TONS: VENTI•:f f :"- r' h EVAPORATIVE COOLERS __ _ _ _ _ YPE. I� HOOD (PER 12!. ORti 12' PTN:•.OF HOOD) xPE.'II:HOOD CLOTHES - DRYER GAS?;:LOG . . MISCEL'LANEOUS_(NOT COVERED, ELSEWHERE)_ VNLISTED GAS APPLIANCE400,000.BTU_; UNLISTED GAS'.APPLIANCEx>400,000BTU USED'.APPLIANCE 400, 000:; BTU Uq,ED,APPLIANCE >400, 000.{ -,BTU t., R'�HANDLER <10, 000 �CF4' ca ',,HANDLER . >10, 000 CFi NOTE MI SIGNATURE d1 J.4* - 161, AFP' 415, X$10. 00 4,5.0 0 !4, f X.10.00 X 12.00 X: 15.00 00 x12.00 X:;;`. 20.00 x.,25.00 x' =35.00 x: ;'60.00 x''12.00 X:-20.00 x,,25.00 x 35.00 X'60.00 X,40.00 x:10.00 x'50.00 = 0.00- X' 00 X..10.00 X .' 10.00 x10.00 x50.0 0 x190.00 x-50.00 X100.00 x10.0.00 x?12.0 0 x" 5.00 SUBTOTAIi'_'~` PLUS: :.P OCESSING FEE EQUALS OTA'PERNIT 0 •:" EE,D.,UE 1L $ .1kane'Coun st 1313 Broadway • Department of Building_ andlafety venue Spokane, WA 99260 • (509) 456-3675