1995, 04-28 Permit App: 95002725 Wood StoveMECHANICAL PERTWIT'APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: /1 03 8 F. •13A0.aei
CITY/STATE/ZIP: 419.3x. PARCEL NUMBER:
OWNER: -It. VV Pi SA / PHONE NUMBER: 9a y S31y
MAILING ADDRESS:
(Street)
CONTRACTOR: 4-&-.10+01-)
MAILING ADDRESS: L.A.)• 7 4n.
DESCRIPTION
(Street)
(City/State) (Zip)
LICENSE NUMBER:.(frfO LS )00 /L4
PHONE NUMBER: 3a(,-73 $&
kkcm 95.2.x/
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER
GAS EQUIPMENT <100,000 BTU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET)
BOILER/REFRIG 1-100M BTU
BOILER/AEFRIG 10'!; -SOON BTI.
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1;0001 1,750M BT[J'',
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 0 3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR. CONDITIONER 15 X30 TONSy
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & AIR CONDITIONER±50 TONS
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
T(PE II;HOOD___,
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE: ::
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED:GAS APPLIANCE>400,000,BTU
USED APPLIANCE <400,000 BTU
USED APP..LIANCE400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER>10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
Ljex
SIGNATURE 120g -C4)20 -/--
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x10.00 =
x 25.00 =
X 10.00 =
x 12.00 =
x 15.00 =
x1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x35.00 =
x 60.00 =
x12.00 =.
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
j
a,5-, a,
SUBTOTAL
$2.4-17 co
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ .573.
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
•
Department of Labor & Industries
Contractor Registration Section
PO Box 44450 4450
Olympia WA 98504-
REGISTRATION VERIFICATION
160 902-5226
TEMPORARY. _ FAX (360) 902-5228
--� From
Olympia Iluadyuortcrs
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RcgRircTWBL-- —/iVi(
Regtsvon numbxRegistration �c!�LJJ6
sent from the
Olympia office and
Registration will be
Contractor: be e: Your within
Certificate of
this record until you receive your
should be received within 2 to 3 weeks. Please keep
Certificate of Registration: Ravin owl( r
F625-036-000 registrantm verification 2-95
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'Thank you
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