1992, 12-23 Permit App: 92011147 Gas Clothes DryerJOB STREET ADDRESS:
CITY/STATE///ZIP:�1 Y
OWNER: �1onJ� �d R ,011,
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
/(% /07 F4RR / d
MAILING ADDRESS:
CONTRACTOR: vrio R S'
MAILING ADDRESS:
_Cernp
PARCEL NUMBER:
PHONE NUMBER: 92.6
(Street)
(City/State)
LICENSE NUMBER:
PHONE NUMBER:
(Zip)
(Street) (City/State)
MECHANICAL WORK
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
.,7,.;V;VI1FfyS :;iti;5':x`,}�,',�;a'Sfi:.f:•`':'".....:r.
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
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HEAT PUMP & AIR CONDITIONER 3-15 TONS
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HEAT PUMP & AIR CONDITIONER 30-50 TONS
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VENTILATING . • .:.:;.:}:';:�:>v•:?::s:�i :}.}.:4.
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FANS
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TYPE 1.11000 (PER 12' OR 12' PTN. OF HOOD)
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CLOTHES DRYER
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GAS LOG
4.v. r. y w$41.0.' ..:,..:
Herwikw
UNLISTED GAS APPLIANCE <400,000 BTU
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USED APPLIANCE <400,000 BTU
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AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE idl fi
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
f
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
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