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1992, 11-06 Permit App: 92009837 Wood Stove
4 - -a MECHANICAL PERMIT APPLICATION FORM - ,, Information Worksheet JOB STREET AD911ESS: liS . ./3-0-4 .651 CITY/STATE/ZIP: U.04ica.42., tAJP- 19w'7 PARCEL NUMBER: OWNER: 1-0d-61,CraG12,,---e-,-) a PHONE NUMBER: '- Ib"' itil MAILING ADDRESS: CONTRACTOR: A.143U:ernal-, MAILING ADDRESS: W. 2-7 (City/State) (Zip) LICENSE NUMBER: it-1/1-71DC-S / 3 4-9 PHONE NUMBER: 32--(-73,8.1. 1,41- 0 (City/State) (Street) MECIIANICAL WORK DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODSToy: GAS WATER HEATER • • • • • • • • • • • • G.ASg91411:WNTAIOQi•-. -•••••Mg.M•go GAS EQUIPMENT +100,000 $TU DUCTWORK) GAS PIPIN (EA OUTLEI) .11•221:: BOILER/REFRIG 1-100M BTU :.4914801gEgglialMl" BOILER/REFRIG 501-1,000M BTU BO1L1REFf1G BOILER/REFRIG +1,750M Eau FWAriPOMEAVRIttittgintifitirg *-- • HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT PUMP & AIA CONIT1ONR 15-30 TONSHEAT PUMP & AIR CONDITIONER 30:60 TONS VENTILATING FANS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPE 11 H000 CLOTHES DRYER RANGE GAS LOG MISPEllANEQU.SINaUPOVgREVK.SeWHefi, UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED GAS APPLIANC >400,00Q BTU USED APPLIANCE <400,000 BTU USED APPLIANCE 40O00Q TUAIR HANDLER <10.3.,.0046F4 AIR >10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x10.00 = x 25.00 = 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 = x 10.00 = 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 = i SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ 57) . 60 Spokane County Division of Buildings West 1303 Broadway Avenue Spokane. WA 99260 (509) 456-3675