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1991, 10-31 Permit App: 9007435 Gas Log, Piping/6/ � . MECHANICAL PERMIT APPLICATION FORM 97 Information Worksheet JOB STREET ADDRESS: S • agog ro k y CITY/STATE/ZIP: 5/0669nE., LUn 9926X0 PARCEL NUMBER: a71-SS'S%= 'iSos PHONE NUMBER: 924'a3J 9 ' ' OWNER: (nm Loa -P - MAILING ADDRESS: _59-frL ^ J- (Street) IW CONTRACTOR: l f ri �L *clldu o t,S MAILING ADDRESS: ?o. au-a-skS (Street) DESCRIPTION .S�dirw :c (City/State) ':�. ,`..; .(Zip) LICENSE NUMBER: Car i/ .2)K?) PHONE NUMBER: �Sc3e0.8:360/ .' 4;06ta t w&_ - 9.'7220 (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE • ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOQ0TQVE/INSERT: GAS WATER HEATER GAS EQUIPMENT::d 0,000 i3TU: INCCUD0S;>; .:......:......: 'GAS EQUIPMENT+100,000 BTU DUCTWORK) • GAS:OPING.(EA':OUI.EI).i=<: BOILER/REFRIG 1-100M BTU BOIL . REFRIG:70 M. BOILER/REFRIG 501-1,000M BTU x:�yw.,. w: :w.:: w.r...wCY.<.m-.rx:..x...,.....n.:..::....:::::.:.nw 60ft,RfREEflIG100U1:`1.a7SOM`BTI); 'BOILER/REFRIG+1,750M•BTU "._'t' '. HFJ1 :PUMP:&„21R,CONDITidNER<_a 3 TANS„<?€>r r: HEAT PUMP & AIR CONDITIONER 3-15 TONS (HEAT RUMR'B :AIR CONOITIONER:1`5-30SONS :.: . HEAT PUMP & AIR CONDITIONER 30-50 TONS- HEAtti,MPB-Ai ddiCip1Tl4N;EP'±50;TONS;<;ay •.VENTILATING FANS :..r 4EVAROR6TIVg COOLERS:i TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) CLOTHES DRYER RANG :..:...... GAS LOG MISCELLANEOUS (NOT.COVERED ELSEWHERE:::°_ UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED:GAS APPLIANCE>400,000.STU i; USED APPLIANCE <400,000 BTU USED AP.PLIANCE.>400,A00_BTU:: <'.1:.>.:<;'.:<,;;:": AIR HANDLER <10,000 CFM AIR:,HANDLER>10,000CFM: :?:::>?' NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATUREact/ ft( �� NUMBER OF UNITS X EACH UNIT .' = AMOUNT; ' x10.00 = x 25.00 = X 10.00 = x 12.00 = x 15.00 = . - . r+ i x 1.00 = x12.00 = . x 20.00 ‘r-- =x25.00 -... x,25.00 x35.00= X 60.00 _ : x 12.00 '_ x 20.00 = x 25.00 =„ X 35.00 = X 60.00 = ... . x10.00 =-x10.00 --• _ x 50.00 X 10.00 = x 10.00,= . x10.00 = ... .-. . - ..-•.: ,-:•;•1.•-•• : ...::. . . ......:..::. . .. .. .... . , -• x10.00= X 10.00 = X 50.00 =- x100.00 = •.'70•O0' x 50.00 = X100.00 = x 12.00 = t x 15.00 = SUBTOTAL PLUS: PROCESSING FEE + $ " 25.00 ' '. EQUALS: TOTAL PERMIT FEE DUE = s .C),i . Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675