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1991, 07-08 Permit App: 91004019 Gas Log, PipingMECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: /" 0/0 G{//LG/Jc(J / / I CITY/STATE/ZIP: 4310/( / a//t- en/ Z PARCEL NUMBER: / 75"t - ' 64/ C7 OWNER: fgy.2JS PHONE NUMBER: 926 - /i 5 -Th MAILING ADDRESS: s7%>V/2 ofP (Street) (City/State) (Zip) CONTRACTOR: 760.41- _ c29'7L mui 5✓ LICENSE NUMBER: 4J1-7706.5 /0Y7/G PHONE NUMBER: 92z- a100 U (zip) MAILING ADDRESS: 7W6 /540-40‘011--(7 (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION (Street) ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) ;WOQIe ti W)�l(i�f�r�'.c .:.vA.9.:.\4`.+'vyr peKvyyPNy>.,`'J,:>::li�ir.'fi ,b$T� 'F�1��FV���esG a< GAS WATER HEATER MEMO a GAS EQUIPMENT+100,000 BTU DUCTWORK) GAS,1P;t:P, �NG{SA O,IJ»Tfa BOILER/REFRIG 1-100M BTU BOILER/REFRIG 501-1,000M BTU romiregoragatow BOILER/REFRIG +1,750M BTU 1E0PI MP & IAIA srgainagrO TANS HEAT PUMP & AIR CONDITIONER 3-15 TONS ;} EA' :P( MP;&AIR OND)T IN X15'3QlTONS. HEAT PUMP & AIR CONDITIONER 30-50 TONS iiialWENITatirgat VENTILATING FANS gvAWIWElktr TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) 7PE1filOf3b <a CLOTHES DRYER GAS LOG MISCELLANEOUS FIQ COVERED ELSEWHERE UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED GAS APPLIANCE '" QO,000 BTU USED APPLIANCE <400,000 BTU AIR HANDLER <10,000 CFM AlR""HANDLER»b 000 CFM i" NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x10.00 = x12.00 = x 15.00 = x 1.00 = x 12.00 = x 20.00 = x25.00 = x 35.00 = * 60.00 = x 12.00 = x 20.00 = x25.00 = I 35.00 = 'x 60.00 = x10.00= x10.00 = 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 = / SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE _ $ pokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675