1992, 10-23 Permit App: 92009259 Wood Stove92 259
MECHANICAL PERMIT APPLICATION FORM LID „
Information Worksheet t(i n �"i. '!.. t 4 t ;� y .
JOB STREET ADDRESS: S • ZDO.F
�l
CITY/STATE/ZIP: '�?a ra �c1 %p C&4% 99013-7 PARCEL NUMBER: '\15' li I e-, r9
OWNER: A? 4 P r'T esc XA --; PHONE NUMBER: 92Z-- b'SFS
MAILING ADDRESS: 5=et 37
(Street) (City/State) (Zip)
CONTRACTOR:► I C i G C-F�.1I-Fv2 LICENSE NUMBER: V- (4 IC -r' &C I i3 bLA
PHONE NUMBER: (SOO
MAILING ADDRESS: f . (13, n ._33,?4:iJi,t
(Street)
DESCRIPTION
rlAl
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WUODSTOVE INSERT:
GAS WATER HEATER
GAS Q IPME T 100 00 _ B U: IN LURES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS: IPINa(EA OmTLE
BOILER/REFRIG 1-100M BTU
(3GILCRI E 11 00M U s
BOILER/REFRIG 501-1,000M BTU
`BOILER%A i=F G `x001.-1,751 M BT
BOILER/REFRIG +1,750M BTU __- - - - - --
HEATPUMP R CONDITIONER
HEAT PUMP & AIR CONDITIONER 3-15 TONS S -
HEAT PUMP & AIR CONDITIONER 30-50 TONS -
N.CONDITIONER_ +
VENTILATING FANS
TYPE 1 HOOD (PER 12' OR 12' PTN. OF HOOD)
....:....:::.
TY'E :i- OOv..
CLOTHES DRYER
GAS LOG
MISCELLANEOUS"(NOTCOVERED ELSEWHERE`:;;
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED::.GAS APPUANCE>400 000 BTl1
USED APPLIANCE <400,000 BTU
USED APPLIANCE_ 400 000 :BTU
AIR HANDLER <10,000 CFM
AIR: HANDLER'>10,000 CFM: >> :
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE�G_
C/92c,i.
PP)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
-�
1 4-----
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 = ,
x25.00 =
x 35.00 =
x60.00=
x12.00 =.
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
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 =
x 12.00 =
x 15.00 =
„j-,.00
_ .
-
,
SUBTOTAL
$ 255,00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ S004
Spokane County Division of Buildings