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1991, 08-28 Permit App: 91005361 Gas Log, PipingMECHANICAL PERMIT APPLICATION FORM Information Worksheet ' JOB STREET ADDRESS: /Z 3 2- 3 Ma- 7/ CITY/STATE/ZIP: 5 fr K.02 -0-e PARCEL NUMBER' OWNER: J 144 a r 75 A PHONE NUMBER: MAILING ADDRESS: 53&v (S1reet)n (City/State) (Zip) I. CONTRACTOR:4'i ett S co -e--- , ce j- 4etartilICENSE NUMBER: 19/ C/o -7o £ ApONE NUMBER: MAILING ADDRESS: 3/( A.) jct.- t -r 5, e 400-1---e 2 2 2- e ! 0- (Street) (City/State) (ZP) . - MECHANICAL WORKSHEET/FEE SCHEDULE . .• DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) • - WOODST_OVE./INSERT:;:;-::•:;:.=-:;:::-ZI:;',;':::;-:::;c::::•1E;'1;:•;•=-1•:;.1;-.:-.;.:-C-:•-;-;••: GAS WATER HEATER 4AS_EQUIPMENT-a:00;00bIllTq(WCtUDESME'E]i-El-Vg-.$ GAS EQUIPMENT +100,000 BTU 'DUCTWORK)-• GAS PIPING jEA OUTLE1) BOILER/REFRIG 1-100M BTU- '24 -"-•;•'•;•:51:4:1;?-c-.:7--,-V.:•.:-Jr;•,:.•! 1'.01.14t112,:grfitgitkragirel.,FIL. . BOILER/REFRIG 50171;000M•BT131,••-4142., 14611:alifEFAfill66.1514aartr BOILER/REFRIG +1-,750MSTU:2•4',- . , • 11.411KOWONW14TOORDT.fiC;igti?[7043TY5Oggelt! • HEAT PUMP;& AIR CONDITIONE15.TONS:±.------,- HEAT PUMP & AIR CONDITIONER .305O TONS HEAffitigA4(IR:ColbiTiONERAISOTeNdeSEi,;::Kk,:ff','E ............. _ . _ VENTILATING FANS._ • .............. ...... EVAP - .... ....... TYPE I HOOD-(PER.121-OR FTN.:OF TYPE II HOOD CLOTHES DRYER GAS LOG . . MISCELLANEOUS:NOT-COVERED ELSEWHERE UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED GAS APPLIANCE >400,000 9TU USED APPLIANCE <400,000 BTU USEDEAPPLIANCE?;40m0BM AIR HANDLER <10,000 CFM AIR HANDLER >10,000CFM:--•-::vt- NOTE: MINIMUM PERMIT FEE IS $35.00 NUMBER OF UNITS X EACH UNIT = AMOUNT x10.00 = x 25.00 = x10.00 = x 12.00 = x15.00 = x 20.00 L..: 17. x 25.00 '...= x 35.00' 160.00'.---•;-,.-t--,t1:-;-4•'•ii-`1- x 3506 = - )10.0o = • x 10.00 = . , - x 50.00 = X10.00 = x10.00= X10.00 = x io .00 = x50.00 = x100.00 = x50.00 = x100.00 = x 12.00 = x 15.00 = ': .-1•?•::- •'••-. . .-; ::::::'-.. eCcir'i-,;:.. , `z :. -`• ., ••:::-.• :...",••:-.'. 2: :,: : ••.;-: :': +: -A •-•:' t ' tfl ' - • • , -• . : ' • ; ,, -;:::'•:'••:fl-.124 :*-• - '--t • I SUBTOTAL $ /( . 0 PLUS: PROCESSING FEE + $ 25.00 EQUALS- TOTAL PERMIT FEE DUE =s 36',iro SIGNATURE Spokane County Division of Buildings West 1303 Broadway Avenue Spokane. WA 99260 f6091 4s5-_R57c