1993, 06-08 Permit App 93004510 Gas Logfuom Ac
344. r UV5 C-5 �w
MECHANICAL .L PER.V,if APPLICATION L[CA t ION FORM
information Worksheet
JOB STREET ADDRESS: I /12 q 0 ci C. e)i-
CITY/STATE/ZIP: V e11SA a 0q (6_)Q, '1' 037 PARCEL NUMBER:
OWNER: KLes (i c . PHONE NUMBER:
MAILING ADDRESS;
(Street)
C1=/JfFti2
9,5-1.0K)
g�5
CONTRACTOR:
MAILING ADDRESS: • (i--' 1
(Street)
DESCRIPTION
(City/State) (Zip)
LICENSE NUMBER: r4 I C.0 6/C. I %3 !, lit
PHONE NUMBER: (_70q) c,..C.--(C' i I 1
�•-,"��rr/t�E },c�:a C192G(e,
(City/State)
• MECHAN!C..\L WORKSHEE±/FEE SCHEDULE
NUMBER
OF UNITS
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
OODSTOVEIi'SS=rx.T:
GAS WATER HEATER
GAS. EQUir A4F ;Ct OO, J 3 a U 13 ICtU'D S `
GAS EQ1_1IPMENT+100,000 BTU DUCTWORK)
:GAS:•::IPIt�iG:` FA:'OE3�"�'�
:,:w.<•.:.o::.•>A,•r.•s:•.�.,`:a>.:�;.-::>:::: �:: �::`�'.�twt..k h..?::�Fca•N:'taYawaacaw757P.�:abxMi::;nN+r;n::..:.},..:
BOILER/REFRIG 1-100M BTU
...-.-.. Rx+•x.•»;s:tt.,.{„},w..;.,p>,.wn-..:y,?;:f. X�A'.:?!�!N.. : y..nY�..�...:n,n:�:±�}o+
.. :.as, .. sx•rrY:.wc:w:;:a}.;�..:::w, �:4:?'5::2::•:.,.�•;:?.,....s:.:A.�:.,..:..�:...
BOILERIREFRIG 501-1,000?,4
-�o��R� FRIG'=.�.>•t3a��-->r������.
.::.:v..w....:.M.:..�,:r,;o.:::.:o«;:.:,,.,M:a.:«,.,.v.•:.:x«,,.,.,:., ,..:w.,a.:,:;:�.�a*':,fr}�s:;iss>-'>,,�;
EOIQ ERIREFRIG 1,750M BTU .. _. -
v..-I .wm:vm•:.vvv.:. +mxwJ,w.w
i?t1i..i,
HEAT P fJMP & AIR CONDITIONER 3-15 TONS • k---
•,�,;.:?rv:n.Y,.w.,,,,:,:,:,w,...m.,,,:,:,.y..,,.>„„,},.a,,,,,,,.:,,v.,M,:3;::; ��%"'>s;> ;�::
NrAT, PUMP:87A-1, CQhNQfT�i3NER 1? 30TGI,iS , "" N">
HEAT PUMP & AIR CONDITIONER 30-5TONS- -- -
_H EAT'PI
T v+Ylmaw::.
AIR'COl`:DIT3C
nYrr«rvA.xvkJN:4.:i .n.:.....:.:.+." wr:;Ji«n:;wv"Wrw.w -.v. •..�:.. .,ti-✓..::::...
VENTILATING FANS _ _
.,.•:eta;;4.{:V-0^;^�'p;;:'v"�y�:,;y:•r);};:ec}�'�ao+�:';.;a!
1t PORA y1/ 'OO:OLi=i3S> . -;<<..:<;:;;4> :;< ;�
::.:.:«.,�c.•,:;c.•«.:.,,::«::.,.:::,...:,..w.:w;.acrwSY:.s ...- ,.v aN::;w.::.•.+.ah,A;+•-
TYPE 1 HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
1
GAS LOG
MISCRLA iti5 ROt GOVEF?ED cLSEWi ERE `. :
UNLISTED GAS APPLIANCE <400,000 BTU
UNNSTED GAS APPUANCE.400,000 BTU
USED APPLIANCE <400,000 BTU
...:............
USED>;APPPLIANCE' 0O,oQo> BTU = < :{> >;;; ;::•:
AIR HANDLER <10,000 CFM
AIR:HANDLER`>10,000`.CFM
•
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
x25.00=
x 35.00 =
x 60.00 =
x 12.00 = -
x 20.00 =
x 25.00 =
x 35.00 =
x60.00 =
x 10.00 =
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 =
x10o.00 =
x 12.00 =
x 15.00 =
.00
/U OL
NOTE: MINIMUM PERMIT FEE IS $35.00
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
co
= $ 36
SIGNATURE
Spokane County Division of Buildings