1991, 11-06 Permit App: 91007623 Wood Stove� =�
-
-3L1
qi MECHANICAL PERMIT APPLICATION FORM(-7)___'clii ES r6
Information Worksheet4� 9
JOB STREET ADDRESS: ') • '--\.� On�\. \ r> S-
\-.C�.
CITY/STATE/ZIP \ Q Ni c_CCQ ‘ CiPi, PARCEL NUMBER:
OWNE-1: �M * • �' -ce� ----f-r•C\ PHONE NUMBER: day - -1 n(o
MAILING ADDRESS: �'c'(`c\_.
(Street (City/State),\ l (Zip)
CONTRACTOR Q P -\ � \'N =4-O\Q LICENSE NUMBER: Ve,\_SS O JZ
PHONE NUMBER: LAU) (0 - `"I' L
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MAILING ADDRESS: �� • CYJJ �-\ \) \S \C VN:
DESCRIPTION
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WO> .;,::.V:..:,N....:.....:.:..
O S 4 I S
GAS WATER HEATER::.:.::....................:...................................
....................... .
>kttU.IYMtN a:<C1:UUVUV:a 1:U:
GAS EQUIPMENT +100,000 BTU DUCTWORK)
..............................................
....1-10•:�NnF4lr%4]f%W]%•:•:WR%tiG•%:•:v:
BOILER/REFRIG 0M BTU
. : t•�::k•:X• a%•:%,•%::4.•::.W.•)'•Y:ii�Jv��'�:<invF$'ih o'ar:°4;`<:•
BOILER/REFRIG 5.01-1,000M BTU
B:O:I.I ERl6:EFRJa1' :QO 1<,75Qti`+t »T
BOILER/REFRIG +1,750M BTU
PUMP>&•`AIR>CONDITI.O:NER'<Q•
-3 TQNS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
H EAT><P.UM.P&`AI.R CO..NtITIONER<1`S_30:TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
:t' 1 r.'i''�:: n I::i �`• i�•e:n:•:<y �Y�:Y� A l i'�h Yi Il l4 .++i�V:�i?•`.?i:{A$tiY'A ii.`•
VENTILATING FANS
..........................................
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
RANGE
GAS LOG
MI•SC, L LANEOu- ••.• Q''''''''''''''..°.: -
T.:. .SEWI1
UNLISTED GAS APPLIANCE <00,000 BTU
UL,I.NSTED.;GAS.AP,PI IANCE?4QQ,000:BTU.;
USED APPLIANCE <400,000 BTU
USED,: APP,LI,:.;:.;....::. < .;';:.:::.:.:.:;::
::iA1:PPL:ANCE:.;;:::;00,000:: gTU;
AIR HANDLER <10,000 CFM
AIR HANDLER'>1.0,000;:CFM' <;; >; :`
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGN ATUR�,��•
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x1.00 =
x 12.00 =
x20.00 =
"x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x60.00 =
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 =
• \
`cam.40
SUBTOTAL
$ .On
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ 5o, ea
Spokane County Division of Buildings
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