1993, 08-20 Permit App: 93007261 Gas Log45271- ZS/ 2
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: e3. 2.1'3 5 ootrr
CITY/STATE/ZIP: tbnirfC 1Wb.. 99 a./co
OWNER: ROI,s'7`eP
141 Cd CR Ae
PARCEL NUMBER'
PHONE NUMBER:
MAILING ADDRESS: Sf5t14-L'*
CONTRACTOR:
7�� l
T & E ENTERI Q
RCNC.
N. 2520 UPRIVER CT.
6PO5N) 483-0(500�
(City/State)(Zip)
LICENSE NUMBER: 7-bC_nTf tO g'1 3
PHONE NUMBER: 4 r5 o f o
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WQODSTOVEi(NSEFi"i34
GAS WATER HEATER
GAS EQUIPMENT 4-100,000 BTU DUCTWORK)
t�[G{i
GASPtPtOl„�.VI,„Witwsl
BOILER/REFRIG 1-100M BTU
C)aLRAge[t1GJ05Wj4Ca:B.TUd
BOILER/REFRIG 501-1,000M BTU
Bp1L�(�lFi�F#?1�;1aii3041:M�3�A75.ON
BOILER/REFRIG +1,750M BTU
H7PU,i inn
HEAT PUMP & AIR CONDITIONER 3-15 TONS
H i41'.P11M1 I AtFt` q,TDl CiOt . d 30'Tgi5 z
HEAT PUMP & AIR CONDITIONER 30-50 TONS
i':::!;FSA,,i.%I nit Obeli elft .{Y 4tgs�
VENTILATING FANS
Wdattgagffigfra
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
PEIt. D<
CLOTHES DRYER
GAS LOG
MIPE4NI=Q:US:;(NU ;CAVE Eb-EtS,EWci
UNLISTED GAS APPLIANCE <400,000 BTU
UtiNS7EC):GAS_11p1?ltAfJG yapptlOn TI.
USED APPLIANCE <400,000 BTU
r.
USap APPLIANCE SIOO,O0U B7U;
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURESIOW y he,
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 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x12.00 =
x 20.00 =
x25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x10.00 =
x 10.00 =
x 10.00 =
x10.00 =
x 10.00 =
x 50.00 =
x100.00 =
a,
2 -:21? -t -
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$ 2n 00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_ $ 4500
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675