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