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1991, 12-03 Permit App: 91008315 Furnace, Piping
MECHANICAL PERMIT APPLICATION FORM ©Information Worksheet JOB STREET ADDRESS: i i o 1.4.2-3 E SS r' o LA CITY/STATE/ZIP: OWNER: +40 ev wlso MAILING ADDRESS: PARCEL NUMBER: PHONE NUMBER: CONTRACTOR:(t`e�l MAILING ADDRESS: DESCRIPTION (Street)_ (City/State) _ l�"1. 10(`if LICENSE NUMBER: i�i �((�T P..� / ' C.J / PHONE NUMBER: .6'7)9 722r-S�D (Zip) / L rD _ %Vl a.=Ce cO 4k.S 414 (City/State) (Street) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) 49.004101.1.61.4.:'V;^{?h::r:'r: w.h?-::{-: eF::Yr ??�•.n 'v{;i ih?:: ': F -v:,-- GAS WATER HEATER GAS EQUIPMENT +100,000 BTU DUCTWORK) XAiP..l : {M: ?• h}}•$i:±-}}-:'ih}{h:7.?:,v,r{iiR{:•?:3}i{y?i':i: BOILER/REFRIG 1-100M BTU BOILER/RFRIG 501-1,000M BTU :{rr{,f::,..vx:::{n:v:::.•..14604:.41...m,....:..0,.. ;}'x•-;fi:f3ryn}••Y:v{r{rry_}w• { .:. rrr 0.v . . ryi}: •.'•',{ ^ ; '__'v,'�i}�{:} Yi {? iii: r5: {{•:{v,•r?ti i}iv:?•tiVi BOILE�fi/REFRIG +1,750M BTU .. }}.?A:�.•.,,.:•:r::.-r}rF•:,•.,hdw•,.{::{,{.1 'HEAT PUMP &AIR CONDITIONER 3-15;84,1.4,iiit7:::!Vallti �,y �+.� ::. y�r:yj.th�;•:r.,;r- .,o -t..,:.... ,R:,} fi'..,:;r.•r : '`:44. -.1W -7'n. ::�•�;yY,}'1??},>E:•:rS: ... .,.-.�•.•.:r: •.v\,::::: n:v::.v vrn: nv},v:: ,„,.. vn hvvx^}::.v.•: ::?:.v::... HEAT PUMP A AIR CONDITIONER 30-50 TONS ::: hv: {::sr { x:r.•:$_ix.�{ r:: Frny.:. 3}n• }r•:xhvh{ .`rf :::::hlt: +T. ? ..ir ..'-S:.A ♦ �•{� . �'•i••Yf•�?:{WnY eitii•'':: ..x rx+i: C•l.. s.•�.' }.hrfi0.•.•f.,::.Ox: m::::•::::::: Arw.riv?:: .ix•3L:w?.w. h:'irk{:•v.••'r?r:r. r::v {•::\ i. VENTILATING FANS r ... :}•:: =:.: .:'t' TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) :pro : ..+•`�•4};:;<„C±,c;{?�`:`.:?;nti ;•:,•torr,?:c£;xRg•'j:�::`+)?it 'x,� -}'>'.::'. fa •2�{�t}f:C;}°:;x.••.?a!:;: }W t: ter;?>x{}:}.}:: s�:�.q?rS•t::{: b:h.:.,{:-:::a '§yJ� rr.,,r }t;C{}c.{}; ;.`;-{:ag. :TR.. '.v.:: i:••{'lr}t { 4. •....:-r Y'r 833.{;9.:.M CLOTHES DRYER vri.•:'• .}j:i':{}i•'~•v '`iiiii±}•}`! F }hv:ik {iv i'r: n•' i �.- :�.. ,f: {}••h:{i{.`,{lj'-':Eii::�i: - :}.n .. ly+f> { .�y': {{:vhf. ... w.v: nv::. .. .......... .:..:ff:: n::. 'vv,..•}.v::t}.•.{t....:t.::nh-..,'v'v.'vr.::.:v:.v}}:>.'trs.A i.:.:. GAS LOG UNLISTED GAS APPLIANCE <400,000 BTU USED APPLIANCE <400,000 BTU y.:....:}y..�i.(j�.y}. �.. xr..: ...:�;�ryi:..: .,n:r n.r}y.1i.(}{+{.y; ..::..y/{:�.y/�jn;/.j{.,.... n:: -'r �: _;:.;::r•: • lR�F4•A' #M CE :�,..,• w'.!+!vE1 ......r AIR HANDLER <10,000vCFM •Yr`Y{ NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATUR (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x10.00 = x 250.00 = 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 = x 25.00 = x35.00 = x 60.00 = 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 = x 5�0�.00 = x100.00 = x 12.00 = x 15.00 = /Z oS- / l - o-. SUBTOTAL $ 0.00 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE 7 =$` 4t,,0 Spokane County Division of Buildings Woct 1 'AM Rrn*riww Avnni in CnntronA W A 000nn'gno% AAR_QR7R