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1993, 03-01 Permit App: 93001110 Wood Stove
MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: c - /3 3c31 CITY/STATE/ZIP: -ke2l4.g PARCEL NUMBER: OWNER: 5 t -h 42_\b.2 A.: PHONE NUMBER: 9 2�--<i'v/ MAILING ADD SS; r I " fl (Street) (City/State) (Zip) CONTRACTOR: /�G✓!r r41x 0 ' LICENSE NUMBER: TV 0 CS / n 1<</ PHONE NUMBER: 3.-6 -'73kg DIC4 '._ ' 9.7--'3 / MAILING ADDRESS: DESCRIPTION (Street) (C'ity/State) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS ...:$<:•:ti ,{.��:::t::,.r rt...5, .:.. y:�:i:};:...i:i:,,:} L': :•}�'n.: •) . . ). p•{.v r::•..}b, i�.::vy.{::::L.}:.: }:.:fv� .•':: �1;:}r`Y• WOODOVVE I B " d:y,,:;:•} ?:: b :.... ...........Ytc.i...G�:?u:�'•.r.Y,,.v�:.ct4: Y,'...c.:..s.., GAS WATER HEATER GAS GAS EQUIPMENT +100,000 Fay DUCTWORK) GAS'IPING EA P .........' .... x. ... .. n4..n.: ;•SL:.ti45v:-.o:v,,.r.gJSm ry?:FJ%Go.:t4J `.r:4:4.: ` BOILER/REFRIG 1-100M BTU BOILP I/tigEal i BOILER/REFRIG 501-1,000M BTU <: 'fin BOILER/REFRIG +1,750M BTU HEAT PUMP "Ali : NPITY t HEAT PUMP & AIR CONDITIONER 3-15 TONS HEgT P.:P �!IR'iQNOjX(?N��Q'N.,., HEAT PUMP & AIR CONDITIONER/30,50 TONS ....:............................................. VENTILATING FANS E... Y::04':0'1:�?fity »'S�'-. TYPE 1 HOOD (PER 12' OR 12' PTN. OF HOOD) TYP!? I HOi ;ttr CLOTHES DRYER RAN. GAS LOG MIS PLI.AN ( 1 QY R Q.: I SiE1NHEF UNLISTED GAS APPLIANCE +000,000 BTU ULINSTED GAS APP41 .t..? USED APPLIANCE <400,000 871.1 USED API I IAN ,QQQ T <' ` ` ,. AIR HANDLER <10,000 CFM AIR HANDLER >1 QQA' NOTE: MINIMUM PERMIT FEE 18 $35.00 SIGNATURE (Zip) NUMBER OF UNITS X EACH r UNIT = AMOUNT x 10.00 x 25.00 = . x 10.00 = x 12.00 = x 15.00 = x 1.00 = x12.00 = x 20.00 = x25.00 = x35.00 = x60.00 = x12.00 = x 20.00 = x 25.00 = x 35.00 = x60.00 = x10.00 = x 10.00 = x50.0Q = x10.00 = x 10.00 = x 10.00 = x10.00 = x 10.00 .= x50.00 = x100.00 = x 50.00 = X100.00 = x12.00 x15.00= / ..2-. 0:3 _.. SUBTOTAL $ 2s' to PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE_$ 5:• Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675