1995, 11-30 Permit App 95009928 Gas LogMECHANICAL PERMIT APPLICATION Q ., q zg
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PROJECT ADDRESS: �% O L L—�l/" %'a. 4 1
OWNER: �� Q /7 Q III DAYTIMEfa? 7-�f ?,
MAILING ADDRESS:
(street)
CONTRACTOR: .Z,( 7vvc_ S hCIO
MAILING ADDRESS: Zi(J /'fig_
DESCRIPTION OF WORK_ _ . ,
FUEL BURNING APPLIANCE
FUEL BURNING APPLIANCE
UNLISTED APPLIANCE (ADDITIONAL CHARG
UNLISTED APPLIANCE (ADDITIONAL CHARG
USED APPLIANCE (Must meet WSEC's min. AFU
USED APPLIANCE (Must meet WSEC's min. AFU
BOILER/REFRIGERATION
BOILER/REFRIGERATION
BOILER/REFRIGERATION
BOILER/REFRIGERATION
BOILER/REFRIGERATION
GAS LOG, GAS INSERT, AND/OR GAS FIREPLA
RANGE
DRYER
FUEL BURNING WATER HEATER
MISCELLANEOUS FUEL BURNING APPLIANCE
GAS PIPING (ea. outlet)
DUCT SYSTEMS
VENTILATING FANS
AIR HANDLER (DOES NOT include duct systems)
AIR HANDLER (DOES NOT include duct systems)
EVAPORATIVE COOLERS
TYPE I HOOD
TYPE 11 HOOD
HEAT PUMP/AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
LPG STORAGE TANK
WOOD OR PELLET STOVE/INSERT
NOTE: MINIMUf1 PERMIT FEE 45 $35.00
SIGNATURE:
t1
Spokane County Department of Building & Planning
1026 W. Broadway * Spokane, WA 99260
Tel- No. (509) 456-3675 • Fax No. (509) 324-3198 $ TDD No. (509) 3243166
Spokane County does not discriminate on the base of disability in the admission to, or trimmed or employment in. its programa or set
or <100.000
> 100,000
or <400,000
>400.000
or <400,000
> 400.003
1-100M BTU
101-500M BTU
501-1,000M BTU
1.001-1,750M BTU
+ 1,750M BTU
at or < 10.000 CF140
>10,000 CFM
0-5 TONS
6-15 TONS
16-30 TONS
31-50 TONS
+50 TONS
(ty/state)
LICENSE: mil( Leo C7 f / 73 D Lc,
PHONE: �o� rc -�1 //
(aty/sta_ te) (2P)
' COST
OF UNITS . 1 /UNIT
C
$12
S1S
SS0
5100
S50
, J S100
_
_
_
_
a
_
_
_
s
_
_
_
_
1
_
S12
S20
$25
$35
60
$10
$10
$10
S10
S10
$1
S10
$10
$12
515
$10
S50
$10
$12
$20
$25
$35
$60
S10
$25
c)
� 37
a
AMOUNT
Subtotal
PLUS: PROCESSING FEE
.00
v
TOTAL PERMIT FEE DUE $ ;j -
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