1992, 09-01 Permit App: 92007082 Wood Stove4
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: E it s a ' , , es
CITY/STATE/ZIP:�1�U mac. �f�, 1Aik PARCLL NUMBER:
OWNER: 5cc • c '.4;?--- teiLOCc, PHONE NUMBER:'a - O "I mac,
MAILING ADDRESS: t i ` , /-„,• •.-••\‹.,c•• te: l p r , 4` 99 zL
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS'
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
•
GAS WATER HEATER
jlGAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
8 8 8 '''"
aillEgiNgoimmat
BOILER/REFRIG 501-1,000M BTU
10
.vny W''.
ar
BOILER/REFRIG +1,750M BTU :'
HEAT PUMP & AIR CONDITIONER.3-15 TONS °
rAWAT' .. `. a ?... e . A
HEAT PUMP. & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN.' OF HOOD)
CLOTHES DRYER
GAS LOG
�.1,tca
it- N
NUMBER
OF UNITS
Bssmg
UNLISTED GAS APPLIANCE <400,000 BTU
:0*:#I 1.1, •;•?(It; Iii i •
•.t;::.•:o::,, ••.c.'•..:.•.w:v,..w,'t, ww.>t,;uaL�c ,:�.,•a,N,an,;acc <•.,•h ''' ,;.•a
USED APPLIANCE <400,000 BTU
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SUBTOTAL
XEACH
UNIT
x 10.00 =
x 25.00 =
x 10.00 =
x12.00:=.
x 15.00 _
x' 1.00
x 12.00. =
x 20.00'' =';:
x25.00'=.'
x35.00_.
x"60.00 =
x12.00,;=
x 20.00. =:.:.
x25:00='
x 35.00
x 60.00:N ='
x10.00 =-
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 =
x100.00 =
x12.00 =
x15.00 =:
PLUS: PROCESSING FEE
EQUALS: TOTAL PERMIT
FEE DUE
SIGNATURE
„> 4
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675