1992, 05-26 Permit App: 92003735 Wood StoveMECHANICAL PERMIT APPLICATION FORM
jj InformationhWo she4t 1
JOB STREET ADDRESS: N L X 10 "' L L1.A Pj) , /.-t!.-iA100 b)
CITY/STATE/ZIP:.5i)t k'v r ck)A, /`c1 2 / Z PARCEL NUMBER: i
OWNER: 4Pl' 4 (E Ok rN p PHONE NUMBER: 9:7-45-77'
MAILING ADDRESS: A, 22o 3 (LLA 6Lr'.. Sp , (.,e/4 , (''l' 2 2 7 -
(Street) / (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
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GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
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•
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
•
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT€P MP & SIR:> ON 1TI.ON 5 3tf<TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
.. EAT PUMP .&.AtR CONI ITIONEI . +50 TONS :.;;
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
E
UNLISTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
AIR HANDLER<10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x12.00 =
x 15.00 =
x1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
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 =
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
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