1991, 12-05 Permit App: 91008424 Wood StoveMECHANICA)_ PERMIT APPLICATION FORM /3 - % ,L _
Information Worksheet
JOB STREET ADDRESS: £ /`/40'/ Ca7aIAn
CITY/STATE/ZIP: 5-
po14n e., IL.a QQ2 / k, PARCEL NUMBER: /V-S%a - o'//
OWNER:fL. F'ip„,i.-o` n PHONE NUMBER: 721-/Jd'O-r%riGay)
MAILING ADDRESS: ff 1110•49,1 ? 3 i -I f� ✓c fro^ yn g tDa 99;10 A
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEM
WOODSTOVE/INSERT':=
GAS WATER HEATER
GAS EQUIPMENT<100,000 BT IAINCt_ ot's
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS PIPING.(EA OUTS «.
BOILER/REFRIG 1-100M BTU
BOILF_R/REFJ?IG 10100M'BTU <'.
BOILER/REFRIG 501-1,000M BTU
001LER/REFAIG 7,A0 i iN-011 BTI
BOILER/REFRIG.+1,750M:BTU
litatiterialisitrabC
HEAT PUMP &AIR ;CONDRIONER
HEAiiPUMP$ Att;CONp .. ..,
HEAT PUMP & AIR CONDmONER'30=50TONS\
HEAT etli & X11R OTiDITt0t3 M97ZOl'1S x :
VENTILATING FANS,,.:
¢ 1091RA OOLt iS
TYPE I HOOD (PER 12: OR 12'.PTN: OF.HOOD)
's
WPit
CLOTHES DRYER
GAS LOG
, D tails A'P`{PPNILOIATNCOVhiI,T0E00#E
N1ttSCBAEtSf
UNLISTEDANG4000BTU
BTUSELDSAPPLIANCE <400,000
tISto APPLt1WCE 5d00;000_BTU
AIR HANDLER <10,000 CFM
AIR tIANDLEH>10,000CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
Sd
x 10.00 =
x 12.00 =
x 15.00 =
x1.00 =
x 12.00 =
x 20.00 =
x25.00 =
x 35.00 ._.
x 60.00 =.,
x 12.00 ='
x 20:00 ='
x25:00 = ,"
..
x35.00^=
_Y•
x60.00
x 10.00
x 10:00
x 50:00 _'
x10.00==
x10.00-
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$
PLUS: PROCESSING FEE
+
25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$
%J` ce
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675