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2010, 10-08 Permit App: 10003298 Gas PipingProject Number: 10003298 Inv: t Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 10/8/2010 Page 1 of 2 Proiect Information: ' Permit Use: 1 GAS PIPING Contact: MOSER INC Setbacks: Front Site Information: Plat Key: Left: Right: Rear: Address: C - S - Z: Phone: Group Name: Project Name: 10437 W WESTBOW SPOKANE, WA 99224 (509) 747-0950 BENCHMARK INDUSTRIAL Name: Range District: Nort Parcel Number: 35123.1111 Block: SiteAddress: 6026 E BALDWIN AVE Location:: CSV Zoning: 1-1 Industrial Park Water District: 107 SPOKANE, CITY OF Area: 24,414 Sq Ft Width: 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Lot: Owner: Name: MOUNT CLEVELAND DEVELPO Address: 7393 MONTANA HWY 35 BIG FORK, MT 59911 Hold: ❑ Depth: 0 Right Of Way (ft): 0 Review Information: Review Plan Review Released By: 4 w ?i — i 0 Permits: Mechanical Permit Contractor: MOSER INC Address: 10437 W WESTBOW BLDG SPOKANE WA 99224 Item Description GAS PIPING PROCESSING FEE Firm: MOSER INC Phone: (509) 747-0950 Units Unit Desc 1 # OF UNITS 1 SELECT Operator: jmm Printed By: jmm Permit Total Fees: Print Date: Fee Amount $1.00 $37.00 $38.00 10/8/2010 Project Number: 10003298 Inv: ./ Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 10/8/2010 Page 2 of 2 Notes • , Payment Summary: Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Mechanical Permit $38.00 $38.00 $0.00 $38.00 $38.00 $38.00 $0.00 $38.00 Disclaimer: Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of the code or of any other state or local laws or ordinances. Signature: Operator: jmm Printed By: jmm Print Date: 10/8/2010