1993, 06-04 Permit App: 93004318 Mechanical Fixtures35 Val 6 503
a-zalECRE;NICAL PBRMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS'
CITY/STATE/ZIP: K S7-0
OWNER:
to, 1L-/4 f&tckf*i
93- 413/8
(dna; /t)/? C// PARCEL NUMBER:
MAILING ADDRESS: /// / F
CONTRACTOR: fun 'TO
(Street)
MAILING ADDRESS: L c O : -71c 0--/
DESCRIPTION
(Street)
PHONE NUMBER: 414 /- 7 %5" ,
?07
MECHANICAL WORK
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVEJINSERI
GAS WATER HEATER
GAS EQUIPMENT<100,000.6TL1(INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET)
BOILER/REFRIG 1-100M BTU
BOILER/REFRJG 101-500MBTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG1,0001-1,j50M STU.
BOILER/REFRIG+1,750M BTU
HEAT'PUMP & AIR CONDITIONER 0-3 TONS <'
HEAT PUMP & AIR CONDITIONER 3•-15 TONS
HEAT PUMP 4.. AIR CONDITIONER 15-30 TONS •
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP 15, AIR CONDITIONER +50 TONS
VENTILATING FANS
EVAPORATIVE COOLERS,
TYPE I HOOD (PER 12' OR 12' PIN. OF HOOD)
TYPE1I HOOD .
CLOTHES DRYER
RANGE •_..:.:
GAS LOG
MISCELLANEOUS,(NOT; COVERED, ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE >400,000 BTU,
USED APPLIANCE <400,000 BTU
USED APPLIANCE>400,000 BTU
AIR HANDLER <10,000 CFM
AIR, HANDLER 510,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(City/State)
LICENSE NUMBER: P 1-C_O/1 /)/7n/Z
PHONE NUMBER: 613(/-q% 7C
9q DI/
(Zip)
(City/State)
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x10.00 =
x12.00 =
,r).(01
P. 60
x 15.00 =
--„,\
x 1.00 =
.)_ 4 L
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 =
x10.00 =
x 50.110 =
x100.00 =
x 50.00 =
•
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$ 04/ M
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
�l
_ $
Spokane County Division of Buildings
West ^(is broadwav Avenue Spokane. WA 99260 (509) 456-3675