1991, 10-22 Permit App: 91007035 Gas Log, PipingMECHANICAL PERMIT APPLICATION FORM
/' - Formation Worksheet
JOB STREET ADDRESS: i.1 • I ani Pi £'(L ..
CITY/STATE/ZIP: S pOK._ ' I Q 2.0 6. PARCEL NUMBER:
OWNER: S4 -wt CAA) Pri.I PHONE NUMBER: 6:1 Z2- " 44
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: FI'4 I C.E) &11i bEiJ CE.1Ji-Eg. LICENSE NUMBER: �4ICD GIC 1-73 b1.(
PHONE NUMBER: (Soa) q'a2(p-&'9 I 1
E . q3; o s.p2A91,(e. S.00,gn1e_ >v14)
(Street) (City/State)
MECHANICAL WORK
MAILING ADDRESS:
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPMENT+100,000 BTU DUCTWOR
q:,r,.}w..vic ..w!+.w..• .: :rvh.?w.v....: ..'++.vx. !-:H-vf.-. • :xnv.•::w.r-: - •-w:•
24.4
BOILER/REFRIG .1-100M BTU ;;? ,
@BMW
BOILER/REFRIG 501--1,000M BTU
PUMP &AIR CONDITIONER 3-15
I R r f
BOILER/REFRIG +1-,750M BTU,
^`u^'°NCMm'nva^" .. .uvwy w.r}c.i;: � }tli;Gh:1
HEAT PUMP &AIR CONDITIONER,30-50 TONS
VENTILATING FANS -
CLOTHES DRYER
GAS LOG
MIsco?
UNLISTED GAS APPLIANCE• <400,000 BTU
ULINS7 ED GAS.APPUANCB Qdi 00
USED APPLIANCE <400,000 BTU
USEI APPLIANCE> OI Q.B'C l:>><
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
992o&
(zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x12.00 =
x15.00= '
..' .
ii.
x 12.00
x 220' 00
x W.V Y,yarLi
"x-60:00"'=%1;
x 12.00“`=. .
x 20.00 =
x 25.00 =•
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 =
'
44. s 74,,1
'
; :
,'. 45,.� Z. f
r cL -4:-.4,4:,--",,:g.- 5,.,
M iYj5
-X ..
r 4._ ,
_
a :.- r-. y
,,,4'.-•-:- e- ;:
::.
.
..
Iv Oo
x 10.00 =
x50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$ / I Qd
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
09
=$ 3(0
Spokane County Division of Bu
I ..♦ !ono o.,..- -...