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1991, 12-10 Permit App: 91008518 Gas Log, PipingMECHANICAL PERNAT APPLICATION FORM Inform/1tion Worksheet . JOB STREETADD.RESS: / LI L' A/1.0<v, CITY/STATE/ZIP: -Sp t-- Lc/ _ 1 9 �l9 CO OWNER: Q/ c91 MAILING ADDRESS: CONTRACTOR: PARCEL NUMBER: PHONE NUMBER: �t�, 10a `r r� (C z-- c� (n (City/State) (Zip) LICENSE NUMBER: 4/104 --Ti: r(1) d/caws( (i)G.. (Street) MAILING ADDRESS: •o, qz2-7,/d Y PHONE NUMBER: DESCRIPTION (Street) / (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER GAS UiPMENT<1 iG 000 S; NCWOiNS..;<=:_ s '.. n GAS EQUIPMENT +100,000 BTU DUCTWORK) BOILER/REFRIG 1-100M BTU TU ga{ MIRYA14.:W m,ys•: BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG +1,750M HEAT RUMP'''. R;CONDIT(ONER. 5 =o N 3 t2: gr as7 HEAT. PUMRWAIR'CONDITIONER 64=50 'TONS j4 of +ate• � b�nh,.,;?•�}{ F " A�" ' +x - VENTILATING FANS TYPE I HOOD -(PER 12'.OR 12'>PTW OF t]/X'yj�y,rL"•4 is,:%`} .cx.•.F{" DAT -aw`Gv"kc-:.' Y-.ifl..tir'acc.,ot�a.. 2Gkrs•,w4iL CLOTHES DRYER • g+v:••.,�. -<ncrs,'-�;:. 9�'.'0..^ ,;;;<c:.,r,-c•;._c:�• �::r:7.�c%�aS•;co;..�:{,�.;r., Y;,... GAS LOG 2k"0.:.I+I�1 ...w�v+.1i.:.....:....:.....vi:auv.w.Jia'4i:+fn,. vww rcnv.w- • -•• ••--• UNUS i 1 D GAS APPLIANCE <400,000 BTU USED APPLIANCE <400,000 BTU AIR HANDLER <10,000 CFM 3.1. NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE„A t-tAirf<-vin,.--- (zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x25.00= x 10.00 = x 12.00 = x 15.00 = x 1.00 = x 12.00 = x20.00= x 25.00 = x 35.00 = x 60.00 = x12.00 ,.x 20:0e=.. v taro-< .... x25.00 x /335.00 = x� .00M _ 60 - x 10.00 _ x10.00 = x 50.00 = x 10.00 = x 10.00 = x 10.00 = x10.00= x 10.00 = x 50.00 = x100.00 = x50.00 = x100.00 = x12.00 = x 15.00 = 1. ( /. Uv .. , . . r `t:ti .f' tg4 .r, ; � .. r "• .., -. ai! 614:. 3y .. - 2 /0,a 0 • SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE _ $ S 6 , GQ v Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675