1991, 11-20 Permit App: 91008051 Woodstove(Q J `- a - O (43 MECHANICAL PERMIT APPLICATION FORM C l , U 03(
cm 0 (Z1U 0 I, 8 S( Information Worksheet
ir
JOB STREET ADDRESS: \ U15 M ? 1 eJr C . ec k Ao •
CITY/STATE/ZIP: <� winPARCEL NUMBER:
OWNER: 01 lei -An ' I\cn PHONE NUMBER: DCS - LICIS I
MAILING ADDRESS:
saaT
_ (Street)
(City/State) (Zip)
CONTRACTOR: EA- ) C)d JI -FR LICENSE NUMBER: r4JC0 &c..1 -73 ,D LA
MAILING ADDRESS: E . g 3 I D 3u E,
(Street)
DESCRIPTION
PHONE NUMBER: (5040 Rc26, - ?C/ I /
S KA�Ie,
MECHANICAL WOR
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GA #'<IPING ii*A OU°
BOILER/REFRIG 1-100M BTU
} EFx :: ; it4 .tea t �‘;--a-A327
BOILER/REFRIG 501-1,000M BTU rte=
kN "v"^r'^^^.�.: �f•+r:.: .}� - %•.:irx.•xxv. •i.:h r?_C<ti -.
- _ i.:•inn.�AreMQWaaHhwSW W# aiY. i N } :Svlx }. .::�
BOILER/REFRIG +1,750M
kA11 C11=1: -T:
.,...wo .•:.,c:-::iaa:}r.::-.:::.,.::..,..a......aia�.....�,:--N.�wcr.Www.acnca.»w.•«....i;•'a,}3s�:
HEAT PUMP & AIR CONDITIONER 3-:15 TONS
!!.}+:^wM>n-n..:.n}�:�'•�M�M�+--:.w..+!�:.wn,..:..,. { n. naPl, •• y:...,rwi:-.:}.:w.Y:n
EAT:: ?t )MP c AIR C05N1 I /W 7
:.a:..-.t�.hw:.,.:: v>],,,,.:.,�.:•.,�. , .,,,�a -•- ,wa�M.:wwy.•.,. ,r«�.N,••.•crs.::�'v'}.
HEAT PUMP &FAIR CONDITIONER 30-50 TONS?
2RIQ++v�•� nM�e�oc. xeu::.,eca,�vrca:
c -:i.---:
VENTILATING FANS _' _
101011ll+-i�`-'-:,-::yAti-i•'�`.-`:3.ff .� •ii::[.}:•i\R }.:
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
GAS LOG
MISGI*i LANEOUS (NOT COVERED ELSEWHERE:
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPUA(CE>400
USED APPLIANCE <400,000 BTU
'USED..APPLIANCE >40:O,Oo0>B11.1.
AIR HANDLER CFM
. ..........
AIRHANDLER>Y0i000 CFM ;>
NOV 1 1J::11
NOTE: MINIMUM PERMIT FL -1S$3510Q4 Y
)..m# 992Deo
(City/State) (Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x12.00
x 15.00
x 1.00 =
x 12.00
x 20.00
x 25.00
x 35.00a
x 60.00 -
x12.00 t
x 20.00
x 25.00
x 35.00 _;'
x60.00
x 10.00 =
-
x10.00 -..
x50.00=
x 10.00 =
x10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
1
213 -c4---)
,-_
;.
., s ;;,4,
,;t,;-;
-
° . <.:.
.
, ._,
-"'`,--.:14., °t>r_.
-.
° A,Av ;$ ,-.1-
„.
,t . >
-`
.. .
SUBTOTAL
$ 3G-> CO
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 5L ED
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane. WA 99260 (5091456-�S75