1992, 09-01 Permit App: 92007126 WoodstoveLok.,6a,b212� ?5
3 L� MECHANICAL PERMIT APPLICATION FORM
l� ' v Iraormation Worksheet
JOB STREET ADDRESS: 4//-� �� ,ELT®�/
a --7rzc,
CITY/STATE/ZIP: SPDKi9NF f(%". f /�
OWNER: keN /{Ji9/•E/f 13iE/M'1
PARCEL NUMBER: i -D% 6 Bica WE5T 0.467 /9Diviia,/
PHONE NUMBER: 7ae-173 '
MAILING ADDRESS: N. /SUS 4-4704( spe.,64/vt / �lJi4� %9d/a.
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECT ' UCTWORK (SEPARATE SYSTEMS)
.::..:::........:.........
.........:........................................::........
GAS WATER HEATER
:iY�:�Y::.:VS:V.�fi::a�1L�:t,i:::�::f Vv:%V;�%_vi{7.:�:::�%:�i.�rV�:��.r•...�:<:(?�;
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
OI:LEA/R;....,:..._.;::,.:>_<.;>:..>,
LBBIIBI•tG.;:>:;.5i?OM:<STU:.;;;;;>:<::<:>::::>:>:»»::>::»>
......:::..:.....:::.:::..:.......:..... . .. ........:::..........
•
.........................
BOILER/REFRIG 501-1,000M BTU
C?ILEFl/rtEFRIG 1,Opp1 1•
,75dM
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AICA CONDITIONER 0- $ TONS:::::
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
,,::. AT PUMP & AIR CONDITIONER +50 TONS....,::
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEV
UNLISTED GAS APPLIANCE <400,000 BTU
ULINS ED AS.APPLIANCE>400, 0 TU
USED APPLIANCE <400,000 BTU
USED.APPLIANG
AIR HANDLER <10,000 CFM
HAN
DL
A1,.D,::..:.,,;:;:;,<,;>:,.;.:>.,:::.>,:,..:.:>ER >1 O.000.Ct=M...................
NOTE: MINIMUM PERMIT FEE IS $35.00
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
/
x 25.00 =;'
x 10.00 =
x12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x35.00 =
x 60.00 =
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 =
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 5-092
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675