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1991, 10-07 Permit App: 91006556 Wood Stove
MECHANICAL PERMIT APPLICATION FORM Information Worksheet • JOB STREET ADDRESS: `D(D,--a_o C'),-,iNv_i.,‘ 0A . CITY/STATE/ZIP,\C.C.c \),...\ c5\ PARCEL NUMBER: ,,/_.5.54Z.5 - 03o q OW N ER\Q.\---CY \ A ---\VS:i-m..‘"aS:_,ONc-\ PHONE NUMBER: / MAILING ADDRESS: t,e..-•;-",•-• (Street) • (City/State) / (Zip) CONTRACTORAe\ S--\)(1£- ...' \) \CQ LICENSE NUMBER; PHONE NUMBER: ---\ciLEI - C--nacA MAILING ADDRESS:iii• (Street) (City/ tate) (Zip) MECHANICAL WORK DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS GAS WATER HEATER GAS EQUIPMENT <1003000 TU (1tCLUOES GAS EQUIPMENT +100,000 BTU DUCTWORK) GAS PIPING (EA ...„: ....,„.:::„.„ BOILER/REFRIG- 1-100M BTU BOLER/REFRIG 101-500M TU BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG +1,750MBTU HEAT PUMP & AIR CONITIONR 0-3 TONS HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT galt& ALR CONDITIONE 15-30 TONS 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) TYPE HOOD .. . . CLOTHES DRYER GAS LOG MISCELLAN EOUS (NOT COVERED ELSEWHERE UNLISTED GAS APPLIANCE <:466,000 BTU ULINSTED.Gd,%s.i.ApKv1/4.NIC;49,0-;qp.p: BTU USED APPLIANCE <400,000 BTU USED APPLIANC >400,000 BTU AIR HANDL' <10,000 CFM AIR:441D,LE.R");19.-00.:;b NOTE: MINIMUM PERMIT FEE IS $35.00 NUMBER OF UNITS X EACH UNIT = AMOUNT x10.00 = x25.00 = x10.00 = x 12.00 = x 15.00 = x -1.00 = x 12.00 = x 20.00 = x25.00 = x 35.00 = x 60.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x60.00 = x10.00 = x10.00 = x 50.00 = x10.00 = x10.00 = x10.00 = x10.00 = x10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = SUBTOTAL $ 5cxj PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ U• CO Spokane County Division of Buildings WaSt 1flIVI PtrrtnritAtt, A'ttenkril fel. in AI A 'tri"'