1991, 02-08 Permit App: 91000440 Gas Log, PipingMECHANICAL. PERMIT APPLICATIaN FORM - - •-•••
Informktioh Worksheet
JOB STREET ADDRESS: 5/1,6.2_ 74—
,CITY/STATE/ZIP:
•••-• c -f PARCEL NUMBER:
OWNER: 15.(1-74/
MAILING ADDRE :.4E -f -.Z, 92. 72_
CONTRACTOR:
PHONE NUMBER: 7920,yzert 49 AE -7
(Street)
-A/AL
7
'5,70
(City/State) . (Zip)
LICENSE NUMBER: rel: 7 67 1 --
PHONE NUMBER: %(7
MAILING ADDRESS:. A2
(Street) ('City/State) ! 2 (Zip)
MECMANICAL-WORSHcET/FEE SCHEDULE.
'"'NUMBEit,'C X EACH ' •
l*L DESIPTION -0F UNITS. .i. UNIT: x=.. AMOUNT<
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)
UNLISTED GAS APPLIANCE <400,000 BTU
UNLISTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
x$10:00 =
x,25:00:=
)P10.00 =
x
15.00:=
xS7-k 1.00
x -12c.00:=
x-2000 -=
x35.00-=
x 60.00 =
x,12:00.=
r2000=
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 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
p4f.X.X.:
NOTE: MINIM k PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= s t pa
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675