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1992, 10-16 Permit App 92009000 Gas Log1.3---°10D ° MECHANICAL PERMIT APPLICATION FORM Information Worksheet p, JOB STREET ADDRESS: ' / `/& o /4GC,eaeA)C CITY/STATEIZI -?oaa- W A_ 9i037 PARCEL NUMBER: OWNER: PHONE NUMBER: Ur -tit " 3 2...7 Z , MAILING ADDRESS: (City/State) (Zip) - - 1 O a C Pre!›5.k1 Cf.d.1fFV? LICENSE NUMBER: rH-tco CJC.1 13'DL.t (Street) CONTRACTOR: PHONE NUMBER: (SC)Q) 1 MAILING ADDRESS: • (-331 i7 S.3t2A0;LC�_ ;''1iA�,iF (Street) ` (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER_ HEATER _ gAirderF .477.7 GAS EQUIPMENT+100,000 BTU DUCTWORK) •: GAS,,F?,I�G�.EA•�Q�Lh4n. n.�{_��::�:;4.::;�:����.��.`:.:. . BOILER/REFRIG 1-100M BTU cf912 c�U gyp) NUMBER OF UNITS X EACH UNIT = A CUNT x 10.00 = zz x 25.00 = x 10.00 = ;, x12.00 = x15.00 = x 1.00 = i -13 D x 12.00 = x20.00 = x25.00= x35.00 = x 60.00 = -...• - f;:: • x12.00=- :-..._- -.., x20.00 = x25.00= -' ..... x 35.00 = ;... x60.00 = x 10.00 = - x10.00 = •. •. x50.00 = ... x 10.00 = x10.00 = • x10.00= j x10.00 = /0,0D x 10.00 = x 50.00 = x100.00 = x 50.00 = - x100.00 = x12.00 = x 15.00 = SUBTOTAL $ t' .vp PLUS: PROCESSING FEE t $ 25.00 }taT •;J ffftWi:ELK}j:;Y.,'{•{':ku•nTiv'••:'{':{•vaQY)Ohni,-0454t{C. BOILERIREFRIG 501-1,000M BTU --- .may. { :,..::.,..,:.. L .: •{L151ff:6N P y � ^ Cyr 4 k:4;4C:^:•, ; :n` W'.`'1A.t�Ux'A:`J4WM'iRlc26t4.{� BOI!EPJ.REFRiG+1,750MBTU;.c':"•-' ^•:mm„!v^„�M'Ivf:M'^.¢yvy{�p,:}:nwv: x:{h Y{rtv. Y' vwiv'W.vv:k:4Cw:iAvh:.w:.Ymbiv.4?•vAv:+i:.,vrivhiwv:K<W:wn4:iwi::�3Y.tiwCh -HEAT PUMP & AIR CONDITIONER 3-15 TONS ----- - HEAT>Pt3.ktrF; $ .ATF GQ�t RFTa.I E i:`:' �53.(3 :rdf4S :.q w:,,, tia,..,..a:.{,1. .:4.,Ea:w:.r ska..4.•�....::.:.,;ax:w•::.:<4>:v4v*-x..:,..:!..:;,:}-.•:: ;s�.:.�::;:-:a:;:xxaxtU:c:: HEAT PUMP & AIR CONDITIONER 30-50 TONS - VENTILATING FANS . ^.'.•.R{..,A.�y+0•.,S Lv •.::i i,Y.•i}{fti v: {• TYPE 1 HOOD (PER 12' OR 12' PTN. OF HOOD) .:-.�.,:.,•{:,�.:�4:e:;s^':y".R:•::vn»?o>:;:4v,.. • . {'�,, yj! n, :o-}r.:ry sspt�v;xn;:; • "r::4?{irk:•i{:>.{i:•r:ti:'-'��.,A4',.''::`:`�%:3:i�, `p,-vJ.:n'+".':�' npy\. i {:4:i: /: :.:..:: i.:i1 ..........................r..so.S::k^•`.�'>:f`$;fi[vw�;:••:-•.::�xL�'•' .5::.'�.:.v�;�:���io-^�ti Y' ti::>Cih::wiYni{'A%:4:'.� CLOTHES DRYER rrE• GAS LOG Mt$QELCANEOUS'(N4?`;OI• ERED?tS-1N1E;"`' UNLISTED GAS APPLIANCE <400,000 BTU ':;.f :..,''''''^ 4j.^:.::•: { :^r:'''>:'"i. DUNS:ED:.,AS'APPLIpivcE.>.....0o1000 iJ �:>......:<:..:.:.:....: USED APPLIANCE <4-00,000 BTU '.USED APPL1At AIR HANDLER <10,000 CFM .:.;V..:,.x:S],??.;.vY'::j:4:.�.•{.•.,::�y.:;:.1+:-�M'•.wxn}vr;r.y�i":i{: '?Gl}';h `AIR EIANDR> NOTE: MINIMUM PERMviiT FEE IS $35.00 EQUALS: TOTAL PERMIT FEE DUE =$ • Spokane Cots~. - t,r, nf Bt.:Mi; 77