1992, 07-14 Permit App: 92005199 Furnace, PipingMECHANICA_L,PEFMIT APPLICATION FORM
Information//Worksheet
JOB STREET ADDRESS: 8 II8'a y ,-PNO/LP 61€ 4-8-1°9
CITY/STATE/ZIP: 51j 4-w4 PARCEL NUMBER: r
OWNER:. ,1 ,(,),,,/ 'ciwd PHONE NUMBER: 9 d 7- `'7 / a tt
MAILING ADDRESS: £'' 1/ a-29 Jo A,ona Ott ,Stcbh-Au-c, co 4511 553c,G
-�
� ' (Street) (City/State) (Zip)
CONTRACTOR:J/-01_C //4'&44j c/ A ci LICENSE NUMBER: Z/ HS 44 3 /3 /414
PHONE NUMBER: 4' ? S' 76 ? i
n
MAILING ADDRESS: c. - 7/73 - oc& p�" S C si' Ce,Ae 9?a7
(Street) (City/State) - (Zip)
MECHANICAL WORK
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVEIINSEKii
GAS WATER HEATER
GAS` EQI IPMEtV`(;.0 00 g0U, Bi U (INCLODES'
GAS EQUIPMENT+100,000 BTU DUCTWORK)
G6S 1.PING;(En'QUIrg
BOILER/REFRIG 1-100M BTU
BQIL.tF1IREFRIG 10 500M oTIJ
BOILER/REFRIG 501 -1,000M -BTU
BOILEH/AEFRIG ,O0 <1 1�750M1r1:::;$'1
BOILER/REFRIG +1,750M BTU •
iNEATiPUkfP.,'&:'At(Vpo ...n!TIQNEFI.:0 3;T'
HEAT PUMP & AIR CONDITIONER 3 -15 -TONS.
HEATPUMf' &MaGONDITIQNEA is4$: 014.. '
HEAT PUMP & AIR CONDITIONER 30-50 TONS
H A ' PLIMp;;&;AI OROITIONF +5.0.TONS;> <=_
VENTILATING FANS
:F• VAPOR X1VE'bO'OLBRSr:_'>^s„'
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE`II€ HO.Opp::::::<.>s:.:'';
CLOTHES DRYER
<RANGE::
GAS LOG
MISCELLANEOUS (I'OT: COVE RED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU '
ULINSTED.;GAS:APPLIANCE>>459 00O STU ` `: a: =.
USED APPLIANCE <400,000 BTU
:USED, APPLIANCE00000:BT
AIR HANDLER <10,000 CFM
:AIR HANDLER:>7tI,0001CF?M;'?
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE./a-770o
NUMBER
OF UNITS
X EACH
UNIT
=AMOUNT
x 10.00 =
x25.00=
x10.00 =
x 12.00 =
x 15.00 =
x1.00 =
x 12.00 =
x20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x12.00 =
x20.00=
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x10.00=,
x10.00 =
x 10.00 =
x10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
/'a-"--
/
.
f
x 12.00 =
x 15.00 =
SUBTOTAL
$ 73 r
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$3g-
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675