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1991, 12-18 Permit App 91008678 Gas EquipMECHANICAL PERMi T APPLICATION FORM / �3 Inform on Worksheet JOB. STREET ADDRESS: ' - • . I r}".�e), CITY/STAT P: PARCEL N JMEEER: OWNER: {l / 0_ Me/A-/'K2 PHONE NUMBER: MAILING ADDRESS: ��• / 7•&' 0,Q( 1/zoc/ (Sttreet) / (City/State) / ! / (Zip) CONTRACTOR: J i r� 5 I -kal /Z LICENSE NUMBER: `J A/��(7" 5.15/ /l%Z( PHONE NUMBER: Y -' , MAILING ADDRESS: 'r//3 U�.CJ S i �/ / / oo3 (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER GAS EQ UIPMENT c100)0013TiiNCt. .........:::.:.:.: GAS EQUIPMENT +100,000 BTU DUCTWORK) >..<I..I... BOILER/REFR IG 1-100M BTU O BOILER/REFRIG 501-1,000M BTU C1 BOILER/REFRIG. +1,750M BTU_ { 1LER :jy , jy� y}�(.C,�y-�fy�y; +M'l` j}wy}y."._:7s:1J( ,',:::..M• ,. ..,« ,... ;:. , .Y...♦t'Qi'. ll.•I �i l(,wIF+..::CONDI +✓T'w} �. y(, [NS Yv .'Fhirwire.,nw,4:v,.,,v:v:W.{vw�Y.'4:v. r,:vGai�.v,aF,v.J.vYA,n.NM4:f:}:?Vh•,T,µ.`?4'w'vJf- HEATPUMP: &AIR CON_ DITIONER 3-15 TONS :.- HEAT PUMP & AIR CONDITIONER 30-50.TONS- :. . F 7� y. �• , �} .�-�s• MP c AIR`- 3ND ON > 5 l' iS VENTILATING FANS A i.-V�: . �E-G-�I L ��;jib I ?l.tat _ :Fifir. .h ::f{: •: ..: �H..+}{:<:%'l. lL ..::: r:>,.:(<!!i-F.4}:gin}, ]:w:::A•.V.Ww.v.riSNh�.:iSvy?.vii -. vvw .0 .v.st\v: A:«?4??i?irilii?i}:•".r{ri�'�•i:v TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) ,.•'^,•Y. ^yM•m{„+ww{MYHr ���y�<)G�F�.,. . <�}l:S�{.}N}: x r � V'{}�rr.tt((;; ��� h/:fFf i�i4 �::v: rv::::::::::.:rvi..,i:: .... x,Y:.Jnv.,vnvvw r:.C,vwh •.. F.-::::::�.v�: v,:3i?[LSVriv.0xt:.:.mrr..........v....v..t......... CLOTHES DRYER r%p'r �3 :r1^v-{<yr �:l: w.?:,1,•:<!{i{.:4 ::Vr,. ::1 is `ili} v.dOv ' GAS LOG UNLIS 1 EU GAS APPLIANCE <400,000 BTU STtp S PP Nt ' 3 `.... USED APPLIANCE <400,000 BTU US AIR HANDLER <10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE 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 = x2 0.00 = x25.00 = x 35-00 = x 60.00 = x12.00= x20.00 = x25.00 = x 35.00 = x 60.00 = x 10.00 = x 10.00 = x 50.00 = x 10.00 = x 10.00 = x 10.00 = x10.00 = x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = / /c)•Q(j cv o2 on l /J. OD SUBTOTAL $ ox1 •DO PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE C7I ' ! =$ • 6 6 Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675