1991, 11-18 Permit App: 91007960 Gas Log, PipingX11-Vic2,0
MECHANICAL PEIIIIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: L2 3e 1 S R0 y, .. :,47,z
CITY/STATE/ZIP: Vie' ' (e - 9' 9 2 PARCEL NUMBER:
OWNER: `,6/ a.2i4z4 ' PHONE NUMBER: 92t -, r 7-3 8
MAILING ADDRESS: 5e21-0
C (Street) (City/State) (Zip)
CONTRACTOR:// "( C45 S t/YcP j LICENSE NUMBER: g(6-41_55
PE ONE NUMBER: 922-370 ✓
MAILING ADDRESS: 5r./ ( ,t) /'cz.-L^-l-'
(Street)
DESCRIPTION
(City S/tate)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WQQ0STOVEMBI=IT>><><>_:;<>=~=>:=:::<::::>:»>::::::::_:::>-:>:
GAS WATER HEATER
GAS: EQUI M IVT` 100 000 BTU O CL ES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
B. > ILER/REFRI i l:01;;:::.. M
BOILER/REFRIG 501-1,000M BTU
B.:_ 1L 3EFFIIG 1' IO0I- t,750M
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 3-15 TONS
H EAT PUMP &: AI <CONOITIO ER y a'` ..O TOt4S'
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT>PUMP 'AI GC 1 DIT
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
.:::::.:::::::........:..:::::::....................................................... ..........
CLOTHES DRYER
GAS LOG
::..:...........................................................................................
MISCEL ►NEOU.S::_ OTCO l ED £L$E' NH)_AE_
UNLISTED GAS APPLIANCE <400,000 BTU
IN
USED APPLIANCE <400,000 BTU
..............................................................................
USEI) APP[ ANCE BTU
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
'2 2 6
(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 =
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 =
/0 , 31-c)
SUBTOTAL
$ //, e'
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ j�`("0
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)-456-3675