1992, 12-08 Permit App: 92010761 Gas Log, PipingMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADD ESS: '7'7/ 9
CITY/STAT IP• t"kd-1 1-V 9 PARCEL NUMBER:
OWNER: ( Luj- I PHONE NUMBER:
MAILING ADDRESS: -..5,4M`6.:,
c\ lc -141
, �-
(Street)
CONTRACTOR: /i'J • it) /JP
MAILING ADDRESS: P /c /V9
(Street)
DESCRIPTION
(City/State) (Zip)
LICENSE NUMBER: 111 ti g L� PNC /62":T .
9 , -4/c$9
i3
PHONE NUMBER:
k/9 /v P, 60/9.
(City/State)
MECHANICAL WORK
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOOpSTOVP/INSERT . .............. ..:..: ...:......::.
GAS WATER HEATER
GAS EQUIPMENT <i00 000. T'U (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
,f ASPIPING.;(�!°
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
HEAD' PUMP & AI GONDITIONPR
HEAT PUMP & AIR CONDITIONER 3-15 TONS
MEAT PUMP & A!R cONDITIONPR. 5..30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & AIR CONDITIONER + 0 TONS.
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
RAN..
GAS LOG
MIS LLANEOU SNI T COVERED E E1+11HEP
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS. APPLIANCE >40Q g00
USED APPLIANCE <400,000 BTU
USED APPLIANCIR>a00,000;BTU........€::<``'::.......
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
a- 7Y) - 4 -Lk
(Zip)
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 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
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 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
/
,1. o a
/e 06,
SUBTOTAL
$ //CO
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ ,36-0o
Spokane County Division of Buildings
WAct 1 ff13 Rrnariwav Avenue Snnkane_ WA 99260 (5091456-3675