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1991, 12-12 Permit App: 91008578 Gas Log, Piping;ti lir/-AECHANICAL PCRMIY APPLICATION FORM IUS' Information Worksheet JOB STREET ADDRESS: n . 3(/ %c1�t /-/c.ated- No ,l'8 -S5 CITY/STATE/ZIP', ka 71 t A. � ' PARCEL NUMBER' OWNER: Broil /ti /h[))/1 `\, PHONE NUMBER: ill- 5 7 g5 MAILING ADDRESS: �(Street)_/(City/State) (Zi ) CONTRACTOR: (-6 r� t' rf'd oo OLS LICENSE NUMBER: tic j JCC la/ c?/,,Ya PHONE NUMBER: 3& / MAILING ADDRESS: • U sk , /L - (4 )fes DESCRIPTION (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) T�OiJWS V En., GAS WATER HEATER GASxEQUIPMENT +100,000 BTU DUCTWORK) GAS PIP NG (EA �OUTL BOILER/REFRIG 1-100M BTU risT Im «; E401 BOILER/REFRIG 501-1,000M BTU ,a mil 'Y' :•.K YTr 1 \ 4 Y^J: it - .aaw .a.,..�-_...:c�w.- •.:i�rati��«rr-•.-.e.-•..-rvaw�.:w•'=:a�.a. s�a:;aa.-xio' BOILER/REFRIG +1,750M BTU -- - ....y .,: ^�^�,r 0�"+'°'p"�: ,r�rA'i., nr77,,7,�°� HEAT PUMP & AIR CONDITIONER 3-15 TONS EA PUMP, 1 IF ONDIT1ONE 15-30 T )NS HEAT PUMP & AIR CONDITIONER 30-50 TONS VENTILATING FANS YAIf1IATYEG9O TYPE I HOOD (PER 12' -OR 12'{PTN. OF HOOD) •CLOTHES DRYER:::..rr.-.............r.-..r...•..v..........r,......--�................. GAS LOG UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED GAS APPLIANCE>400,000 OTU; USED APPLIANCE <400,000 BTU ;SSD APDL ANC 40 ,{ A BTU .... AIR HANDLER <10,000 CFM AIRHANDLER >10.000 NOTE: MINIMUM PERMIT FEE IS $35.00 1)-(// SIGNATUR,C� , (4- NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x 10.00 = x 12.00 = x 15.00 = x 1.00 = x 12.00 = x20.00 = x25.00 = x 35.00 = x 60.00 = x 12.00 =- x 20.00 = x 25.00 = x 35.00 = x 60.00 = x10.00 = x 10.00 = x 50.00 = x 10.00 = x 10.00.= x10 .00 = x 10.00 = x10.00 = x 50.00 = x100.00 =_ x 50.00 x100.00 = x 12.00 = x 15.00 = % /, o • . • - ,,_ ... .-. - f(), , 06 SUBTOTAL $ ! /:0() PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ 00- OD Spokane County Division of Buildings West 1303 Rrnadwav Avenue SnnkanP_ WA 4A2Rn NMI 4 f_4R7c