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1991, 11-04 Permit App: 91007538 Gas Log, Piping- 040 lil(_t_Ca.C5-T 2n th La 6 cA JOB STREET ADDRESS: 9 1 - -153c6 • MECHANICAL PERMIT APPLICATION FORM Information Worksheet ) 3 )0q Ut+/- Dr CITY/STATE/ZIP: S ri)Kann_ft_ rn qqai 6 PARCEL NUMBER: OWNER: ZA_A ,yxotA/rA fl4afi PHONE NUMBER: °72q -p95 MAILING ADDRESS: (Street) CONTRACTOR: 5:1- len GArzoi---- id CEA)/Fie MAILING ADDRESS: 6. 13) D _50eA31,(e, • (Street) , -- MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION (City/State) (Zip) LICENSE NUMBER: E4JC,o&c...r7abtA PHONE NUMBER: (50c1) qac, -e9 Sloo.AAJe_ 4.; A 992 Deo • (City/State) ••• " • ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) f• ft 14- "Mir000sToveitstsenti“;:ii,;z::&i:-;'iiEgin;V:RgiNE.1 GAS WATER HEATER; .•- • • . Q.21;81,E01/1-PM'ENT,k160;60CiiiTifiliiC1111DISiggi'akrig GAS EQUIPMENT +100,000 BTU DUCTWORK)':''; itg:11,E BOILER/REFRIG 1-100M BTU4•4:1',41•;fil,::••'•±•...-:4;e!,,kt-tiF; 1:1:?'..?irtiPTIO/R."—EfignelLCITOTIAMPInitar12 - 4.41-BOILEFUREFRIG 5014,000M l'if,yi;f••,tiojtagifigrogiatoktWrkers Et.TV-5:17sitipan a BOILER/REFRIG7+1;750M-BTU2.trilkt,14-. 11.1LPaRenEtc10M0n190..101011.014PIRF:770 r HEAT, PUMP NAIR CONDONER 3-15 TONSILT:„;?le.A-• 4104EATFU1:4,R1[YM3iiepigoiTiONc53olitpus;got VI HEAT puMP:AAnicl2NDIT1ONER3040TONaV24;:f;t1 amumWrailivOrectmollibiagacircifftWarg4 VENTILATING FANS?;*triz•&'`,*::•477:45A14--1iffirt•-„---.-1:t.:t:tL7,3- POWA-Thret.TOVII,E#Wit2YEZT-37tii„Halitrrii 7.4 -,,TYRE I HOOO(PER-1 ''' OR 12' PTN: OF HOOD):f•E::. CLOTHES DRYER - •-• • : • ..„ - _ GAS LOG ;,.2 kAriniv fro MISCELLANEOUS (NOT COVERED.: gt.sEwilEntlie UNLISTED GAS APPLIANCE <400,000 BTU Ulli1.5TED:GAS APPUANCE>400,000 8Th USED APPLIANCE <400,000 BTU -USED- APPLIANCE 5,400,060:EiTtP);;::::.•4:-.1:_ity::::::::1,:ii.;;:i AIR HANDLER <10,000 CFM AIR HANDLER CFM NOTE MINIMUM PERMIT FEE IS $35.00 SIGNATURE Spokane County DMsion of Fui!ctinor, • A,,on:tc• kfi/A - • - NUMBER OF UNITS ' X EACH . UNIT : ' , . • ' = AMOUNT •:•1 ‘--::,-.•Ty--X -•-,'••;•: - x 10.00=* x25.00°.:,1) , x 10.00 = - it 15.00,-td:.:‘.7 :.,*4-1-001;47'i.; :Viii12:69f.: z; k2(.0.0?4,::::,!„: ill 38.1:1B2!1-'41 pi60.00;424-' i'4 '-i 12 0o'77at.? ri.i26.6117.--Wf. ' x 25moc=1.0.z •Fr;:-.';'. ;:c.-47: =L--;:-- ; :`. ; 1- . .s• c' - :,- -.I:, -• :-I•f,.- -- - - *-• •-•:-•'•:, i".• 7 4;''')..F2P '.::::.1.‘;',.a. ./.0....':: Ell'itiLte,r).:Ti::1: 11.5e;11::31?)::'31P:21C :`'.!1",;,'..?-ret4ir;t.?,; :1 larilifel,:i'v-r4;talfli:V.-...5dgcfO?4;67,_ fitPidfaili:4141P11 4...S.-;;;:ti:t(eigf*Eit, , ',7•TOltg‘tri,',;-51‘.W'.. 4I'Atiltvit.1c4r-S, iMX4•;-:; •-•-i5g':Mi'lc4F.T:A•-r•,,'?:,Pt- rearst.7.);;;;34-s.?w, ni-- .,1;-.11S3-..tiztetf --4-2;iii,-•;;;',4r..mtt.:::k2ii,. ‘:4).-g,;;LV'.)-:ic,-!;:i-f;;;.-- 454;,:;,--,,-s.r.v.:,,,,,,oi:. ',isi:_iii-aitiiis-riisw.,,, .5'...661 .5.1.ic 60.06;at,:t '21 0.00:-;•- '. Z-RS.06P: ri 5606;:4; x 10.0O - =V: x 10.00=1 x io.00 .: x 1 o.00 = x10.00= x50.00 = xi 00.00= x 50.00 =- x100.00 = x 12.00 = x 15.00 = :r -i -L fc'01:-fil.4•:"-r?,:a.5.17,42.- ::',.-421-A7,-Air.A•1.11T tkie..*ri.:57,1 - zereiniA":.:11.-7;7,•,.:4; 4,:;'4$1,;•,a'.zw.4:i3...i•:ci.;;;:i ,.:::•,,it,:::it.irr,,:.,-,?-, --,-;-._ ...- • ::.,:: • •--- ,L , .. • SUBTOTAL $ pa '& PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT,, FEE DUE 00 =$ 1 7