1992, 11-02 Permit App: 92009622 Wood Stove_.. GLZ- q(ozz (lt(1.' Mt pi
MECHANICAL PERMIT APPLICATION FORM 6 (r7S 23lc)
eU S - Information Worksheet n
�, JOB STREET ADDRESS:`�%J Itt/U FU &. C,�(-1=,-) 262 `q` (��I Th5Z
CITY/STATE/ZIP: 4JOKQ,4 we .990a0� PARCEL NUMBER: _ kS t7 i • 0/P4
OWNER: LCki ThCr{ YU\,J PHONE NUMBER: (;1/ft - a c9S/
MAILING ADDRESS:
(Street) (City/State) n (Zip)
CONTRACTOR: (&(I (L. -t:. .Pce '(u e.es LICENSE NUMBER: LOC i a1 Pc. to ((•(1-1�^ (, _ PHONE NUMBER: 53(0- f-36 /
MAILING ADDRESS: P () BOA as 'J L)O?/CQ,LL Lc.\C, 9°ZZc
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT.::. _ .?f:I'/Y i' : `' ... Y :: _;
GAS WATER HEATER
;GA&EQUIPMENT <100,000:BTU.,(INCLUDES • •
GAS EQUIPMENT+100,000 BTU DUCTWORK)
'G AS: PI PI N G, (EA`OUTL
BOILER/REFRIG 1-100M BTU
;BOILER/IEFRIG 101-500M
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG,:1,000T-4,750M BTU; ":'.: ; '.
BOILER/REFRIG +1,750M BTU
IHEAT:PUMP A AIR: CONDITIONER 0-3:TONS: ` _.:._
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT,,PUMP:&:AIR:CONDITIONER 15-30:TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
'HEAT;PUMP,& AIR CONDITIONER +50.TONS:
VENTILATING FANS
;EVAPORATIVECOOLERS ..:.:::...::..':;
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
>TYPE.II HOOD-. `'.:
CLOTHES DRYER
GAS LOG
MISCELLANEOUS COVERED:ELSEWHERE: __ _ , -
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED. GAS'APPLIANCE >400;000:BTU:•.-1 E -
USED APPLIANCE <400,000 BTU
USED, APPLIANCE >400000 ETU
AIR HANDLER <10,000 CFM
AIA;HANDLER>10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATUREant-- a-75
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x12.00 =
x20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
%
c9S.00
SUBTOTAL
$ €5.63
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ SO. OD