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1991, 12-04 Permit App: 91008360 Wood Stove
MECHANICAL PERMIT APPLIC5110N FORM acgeki2.4 / Information Worksheet e / 5 7 JOB STREET 6- ADDRESS: -7 IICI I:4 IA tif el: 61 CITY/STATE/ZIP: C P a 4 ' 7,1 A 4c W * q 9-1( )--- PARCEL NUMBER: OWNER: 1--/I'7 /14- bil PHONE NUMBER: q 2 2-- - 0' MAILING ADDRESS: 2 / ( Co C. /-:;/// (/ /6-7(-4-1 (5,4q,--- GjAi <-7,7 (Street) (City/State) (Zip) CONTRACTOR: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER GAS EQUIPMENT +100,000 BTU DUCTWORK) BOILER/REFRIG 1-100M BTU BOILER/REFRIG 501-1,000M BTU ii..321111111:1ED31-91:10q.PligThOWPIPP625;::°5:&.c BOILER/REFRIG +1,750M BTU OFST4ROM.MAIRLOPN(LOVNg/V14:31,MbIttg, HEAT:pumR.8...:AIR CONDITIONER 3157TONSA,„.;,,.. 11.7'W3PiciaaN..traPITIO1010:2:5;121TOICIC7gS• HEAT PUME&AIR CONDITIONER 3050:TONS, itiokiPqm:RiStc5I1/410:mgel4savfigniMIN VENTILATING FANS, - : ,, -2 • WARPWIVET/4910.PRO-1041,03105FC TYPE I HOOD (PER 12' OR 12' PTW. OF 1-1056):‘:.' Tigatiagfianaglanata CLOTHES DRYER.. ERO.,e7.525ZSMAINgtealeMagasit GAS LOG gra:I*11):00:01NOWPVERPLEI.-Sr.TWatilelf" UNUSTED GAS APPUANCE <400,000 BTU 114,11„sigrt4s:TARRPANCait0Pagkifranai USED APPLIANCE <400,000 BTU 34..QAPP14.409.g.0.4903)00111Thi&44bii6aill..1.P4:, AIR HANDLER <10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 (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 25:00‘ x 35:00 x10.00 4, x10;00 x 50.00 x 10,00 x 10.00 x 10.00 x10.00 x10.00 x 50.00 x100.00 x 50.00 x100.00 x 12.00 x 15.00 = = = = = = = = = = = - 1=; e='" = = = = = = = = = = = = ';' - - -" ::,3 ', • SUBTOTAL $ PLUS: PROCESSING FEE + 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ SIGNATURE Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675