1993, 09-21 Permit App: 93008607 Pool•
Spokane County 7.3"'
DEPARTMENT OF BUILDINGS
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
INFORMATION WORKSHEET,
PARCEL NUMBER:
STREET ADDRESS:
CITY/STATE/ZIP:
SUBDIVISION:
BLOCK:
LOT AREA:
# OF BUILDINGS:
3610
S 0.69/2..)22
0.1f9. 9'9 Z Bb
M
LOT:
F/A:
ZONE: DISTRICT:
WIDTH:
DEPTH: R/W:
# OF DWELLINGS: WATER DISTRICT:
OWNER: '�` S O PHONE: Z? % --922- O/c‘,
.5-1 0 $
MAILING ADDRESS:
CITY/STATE/ZIP: ...ced6t//9-'-
CONTACT:
n
SETBACKS: - FRONT:36 LEFT: 10/
PERMIT USE:
/41 46..,-e.r
PHONE: 5-0-
RIGHT: a, REAR: 56'
12?SOoo^11e
******************************************************************************
BUILDING INFORMATION
CONTRACTOR LICENSE NUMBER: ,69-ef-c0../)..7'•-= .'t1
CONTRACTOR: Ar5e !'it/QX �iv . PHONE: sal -2$67.-- 6 J V c -
MAILING ADDRESS: I— /3S .)--c( 4W 4%i'Jf2((
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS:
NEW: X REMODEL: ADDITION: CHANGE OF USE:
DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES:
BUILDING DIMENSIONS:
X (WIDTH X DEPTH) SQ. FT.:
REQUIRED PARKING: # HANDICAP: SPRINKLERED: CRITICAL MATERIAL:
JOB STREET ADDRESS:
MECHANICAL PERMIT,APPLICATION FORM
Information Worksheet
3 s'� o s oee4.e
CITY/STATE/ZIP: )/4- .. ' 5 ZO PARCEL NUMBER:
OWNER: e,ualP PHONE NUMBER: 92 2/8-4
MAILING A DRESS: 3.5N/ 0 S e9. ffie c,.4- 9' .oL
(Street) (City/State) (Zip)
CONTRACTOR: 4.64 LICENSE NUMBER: O37 L-1=-?VV/GY°
PHONE NUMBER: qZf-6s-es-
MAILING ADDRESS: (35;2 ( s_404074. -
(Street)
_ 9 (Street)
MECHANICAL WORK
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTQYE11:4S:ERT
GAS WATER HEATER
GAS EQUIPMEN ' <100,000 BTU {INCLUDES
GAS EQUIPMENT +100,000 BTU K)
GAS: PIPING: :.::
BOILER/REFRIG .1
1-100M BTU
BOILER/REFRIG 10100M B
BOILER/REFRIG 501-1,000M BTU
BOILER/RERRIG x,0001 1 750M BTU,
BOILER/REFRIG +1,750M BTU
HEAT:PUMP;& AIR CONDITIONER 0 S TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEATPUMP & AIR CONDITIONER. 5 30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
;HEAT PUMP & AIR. CONDITIONER;}50 TONS
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
RANGE
GAS LOG
MISCEL.LANEO S (NOT.COVERED LSEWHEF
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE 5400;00:0 BTU ::
USED
<466,66
AIR
BTU
AIR HANDLER <10,000 CFM
AIR::f�ANOLER :10000>CPMENGEM
NOTE: MINIMUM PER t, FE IS $35.00
SIGNATUR
(
it/ P4-
- (Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x15.00 =
L. (
/S.4a
1
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x25.00 =
x 35.00 =
x60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x50.00 =
x100.00 =
x50.00 =,
x100.00 =
x 12.00 =
x 15.00 =
l o�
SUBTOTAL
$ /,66
PLUS: PROCESSING FEE
+ $ ZSi0e-
EQUALS: TOTAL PERMIT
FEE DUE
/ . Bch
= $
pokane County Division of Buildings
Woo 14n4 Prnariwav Avant is SnnkanP. WA 99260 (509) 456-3675
j- DETACH TO DISPLAY CERTIFICATE -�
DEPARTMENT OF LABOR AND INDUSTRIES
THIS CERTIFIES THAT THE PERSON NAMED HEREON IS REGISTERED AS PROVIDED BY LAW AS A
REGISTRATION NUMBER .
EXPIRATION DATE
CCO1
fOOL,Z*241tp
01!29/94
t.FFCCTIVE DATE
02/17!70'
WA 992140927
STATE OF WASHINGTON
F625-052-000 (3-92)
L DFT.ACH TO DISPLAY CERTIFICATE _?
Today's
date:
Site address:
['m proposing to build:
ORIGINAL SITE PLAN
•
Parcel number or
legal description:
irf