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1993, 10-27 Permit App: 93010362 Gas Log, PipingOWNER: ��it MECHANICAL PERMIT APPLICATION FORM raj Imotnlation Worksheet JOB STREET ADDRESS: /0 70 7 < . c.7 9 CITY/STATEIZIP: OWNER: � �� A�/fOA 7 ��4. 990( � �Cr.4 � 2 MAILING ADDRESS: 4 a -->..L s/tfeet) (City/State) (Zip) CONTRACTOR: )49e---1,-; y LICENSE NUMBER: /V oR 77/,I 0 7,„ Jo tPH NE NUMBER: 9 - 1.,&C B/30/9c o , c�a . 9.) /3 (Street) ' (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE PARCEL NUMBER: PHONE NUMBER: 1 MAILING ADDRES DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) QP!RS 't ,1„ )05, GAS WATER HEATER :d`^f:FS''SSA>�.:'��'.•�.A��f1�!•!RSS:$:(. R•MM ..unci>w� .�. w�.:�; :? . Y .-:tfi GAS EQUIPMENT +100,000 BTU DUCTWORK) BOILER/REFRIG 1-100M BTU (INCLUD BOILER/REFRIG 501-1,000MBTU BOILER/REFRIG +1,750M BTU HEAT PUMP & AIR CONDITIONER 3-16 TONS HEAT PUMP & AIR CONDITIONER 30-60 TONS }ii `QM(l ailk0.0ps 11 ,''. VENTILATING FANS b..s (l O TYPE I HOOD PER 12' OR 12' PTN. OF HOOD) itogiOtiO CLOTHES DRYER GAS LOG . ific rtiki t Jr -R30&• ,�yi F7.,`,.�Ii14; Iw�7 llyf�. UNLISTED GAS APPUANCE <400,000 BTU USED APPUANCE <400,000 BTU AIR HANDLER <10,000 CFM g? NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x25.00 = x 10.00 = x 12.00 = x 15.00 - 82x 1.00 _ -10 x 12.00 = x 20.00 = x 25.00 = x35.00= x60.00 = x 12.00 = x20.00 = 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 ,qa,p0 x 10.00 = x 50.00 - x100.00 = x 50.00 . X100.00 - x12.00 = x 15.00 = SUBTOTAL $ PLUS: PROCESSING FEE `.60 + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE �! _ $ `f d0 Spokane County Division of Buildings West )O; $(oa(Iway Avontin Spokane. WA 99260 010(11 Ar;“ 1(17r.