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1991, 03-28 Permit App: 91001436 Gas Log, Pipingc3 - -3 PLUMBING PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: ,t/ ?G/_5— 4,,(e-v4--- CITY/STATE/ZIP: ,,�rCITY/STATE/ZIP: PARCEL NUMBER: /9 cS/S- pi -Po c, OWNER: ./"C</',C An -14r PHONE NUMBER: 7'— e, 32) t MAILING ADDRESS: n-f-e.t,0s t (Street) (City/State) (Zip) CONTRACTOR: /,/ilcMo 'V Srrdie rc LICENSE NUMBER: .,0 9,PD..t.icS .S /off Jt n PHONE NUMBER: MAILING ADDRESS: / O .� •• �,1 Ant/dye irs y'pow/ (Zip) (Street) (City/State) PLUMBING WORKSHEET/FEE SCHEDULE DESCRIPTION TOILETS SINKS SHOWERS BATH TUBS:: KITCHEN SINKS DISHWASHERS.' '; GARBAGE DISPOSAL CLOTHES -WASHER:` UTILITY SINKS ECECTRICWATERHEATERS =: FLOOR DRAINS ri . r NF:LOORSINKS^s BAR SINKS.-- .. . • ROOF DRAINS €i`:I>' ''.::::€ LAWN SPRINKLER SEWAGE:EJECTOR'` WATER SOFTENER . URINAL:_ DRINKING FOUNTAIN NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE NUMBER OF UNITS X EACH UNIT = AMOUNT x 6.00 = x 6.00 = x 6.00 = x 6.00 = x6.00 = x 6.00 = x 6.00 = x 6.00 = x6.00 = x6.00= x6.00 = x6.00=.;, x6.00 =: x6.00= x 6.00 = x 6.00 = x6.00 = x6.00 = x 6.00 = 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 MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: CITY/STATE/ZIP: PARCEL NUMBER: OWNER: PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) CONTRACTOR: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Zip) (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) .WOODSIOVEANSERI'M ...................................... GAS WATER HEATER • dAkElotiOMENT::::..661:660Intu(INallibti GAS EQUIPMENT +100,000 BTU DUCTWORK) GAS!:pIPIStalEA OUTLET), BOILER/REFRIG 1-100M BTU 11,01111EFUO.P.A1.01401400M13TLIMt:ei4,!Ii BOILER/REFRIG 501-1,000M BTU 0it:WAEFRIG ii:,00011E,75614:13Tt.1•1: !?j! BOILER/REFRIG +1,750M BTU Hmtepm.P.A-AtilErPONOTIQN?9:94:TONg HEAT PUMP & AIR CONDITIONER 3-15 TONS HEA.T4PAIMP„184AIRIc01,4PjligNE131.543...017ONS.:;f4 ' HEAT PUMP & AIR CONDITIONER 30-50 TONS. MEALTIPPM,P4AlfYlOONCi.1TION. .13:43VIONS VENTILATING FANS - • :EVAPDFIATIVECOOLERTnTf"'::‘”:' : TYPE 1 HOOD (PER 12' OR 12' PTN. OF HOOD) - CLOTHES DRYER GAS LOG MISCELLANEOUS (NOT COVERED UN USTED GAS APPLIANCE <400,000 BTU uostsy.gptASjANVANcE>i:409;0001.13W.;:i USED APPUANCE <400,000 BTU AIR HANDLER <10,000 CFM AIR HANDERio;coo:CFM NOTE MINIMUM PERMIT FEE IS $35.00 SIGNATURE (zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x10.00 = x 25.00 = x10.00 = x 12.00 = x 15.00 = x 1.00 = x 12.00 = x 20.00 =' x25.00 = x 35.00 = x 60.00 = x12.00 = x20.00 = * x 35:00 'ciltle-- x60.00 _=.:' ch, x 10.00 = x 10.00 = x50.00 = x10.00 = --4 raw = x10.00 = x10.00 = x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x15.00 = / /0 / 7? - 177 y - . . - '1"-,•-: "":1:1". : ! - ,':-Cfr-'1-44,1-•,- 4 /O- _ , 1- . D -- SUBTOTAL $ «6 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE az) =s 9 /- 3 r / 0 7 Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675