1991, 12-04 Permit App: 91008363 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS:.S 23 a-8 G'L e/`f /
CITY/STATE/ZIP: 5f trtil4- 5 -O
OWNER:
MAILING ADDRESS: -S/4 ry
PARCEL NUMBER:
PHONE NUMBER: 9?.E =7?S6
(Street) (City/State) (Zip)
CONTRACTOR: OuU LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
MYSV::.F•. •:7,.;., c.--:,'..:Y,u..,yrj ,7��p �i�:.......:....r'. t.` y..-. �•rrr.•' . yS' }
1F�� fi:#::�'v�W�7c•C ....•:..:`_9:'.a�,' `2 N
- r
..::v;xr wW:y:'-..:.=::,�,.,..a,' - :.-:::::::-:::::::::::::.::.::: •..v.,•rt::;::•::'.-:::::a`x, a•-•-• aN'
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
Wwvin� -' �� - ' L:.nr:• �� vWii. t,w' N46•r2�YX:�:'�iCs'S'C0.tiv SGJF
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
HEAT -PUMP B AIR CONDITIONER8040xTONSi i -'
VENTILATING: FANS .,
TYPE I HOOD (PER 12' OR 12'. PTN. OF HOOD)_
CLOTHES DRYER
GAS LOG
7.1
UNUSTED GAS APPUANCE <400,000 BTU
USED APPUANCE <400,000 BTU
AIR HANDLER <10,000 CFM
iff.r%vrov:.rv'w::rr::.w::},+t:i.::iv'.rvS:v:.:: r.:�:i:-:,w Nrk 4:J :vin :
NOTE MINIMUM PERMIT FEE IS $35.00
SIGNATURE
/r
gip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
U N U U II U U U U N U yN � N N N. NN N N N N N N N N N N U N
88888888888, 8$8 481888888888 88
x x x x x x x x x x x xK<)C x'x x' x x x x x x x x& x c x
h
' . ..
airA
i
ONE
10-613 __.
k e 4'1
/L% , 0 O
1
SUBTOTAL
$ fib, o 0
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
zys, 0 o
= $
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675