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1991, 09-17 Permit App: 91005908 Pellet Stove
JOB STREET ADDRESS: CITY/STATE/Z1 OWNER: C J MAILING ADDRESS: MECHANICAL PERMIT APPLICATION FORM --Information Worksheet gals. �. ) 0152. PARCEL NUMBER: 57 -'022 PHONE NUMBER: q - `t r (Street) CONTRACTOR: 1" A) C_O C K12DEiJ CE,I#F✓e LICENSE NUMBER: Fi4IC O ri I'3 D L( CC PHONE NUMBER: (Soa) V -?91 / t - MAILING ADDRESS: • g3I D 9ut S1pokA,Je._ LJA 992Olo (Street) -=:.: • (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE : _.- DESCRIPTION"`'._...< ._ .:�'=:z�„_:.c•;:".. �-; :: ELECTRIC/DUCTWORK (SEPARATESYSTEMS) a;' VY00[1STOVE/iNsERT ;= �r'i x � rm' i? r k ; GAS WATER HEATER,`S4-� 2AS:EQUIPME;z1A0..000.8TU'(INgitDES,°° z'µ; GAS EQUIPMENT -+100,000 BTU DUCTWORK)°r=?- ' GgSMPIPG i OUTLE3a� BOILER/REFRIG .1-100MBTU? '113- OLi:t/. , EF :.,_ BOILER/REFRIG 501-1,000M EFRROOblarann W ;.BOILER/REFRIG +1,750M.BTU :s an rtt `"“: 9,ifr'" �4. +UMeflMR:CoND}nONEAttWroNS1§-L HEATLFUMO AIR CONDITIONER 3 15±TONS r•- Tir M.P Ffi o,!o ogE1 To s x f' HEAT PUMP A AIR CONDITIONER 30-50 TONS;"°;,—',•_,, EAT I TIWA ND TWP, ±3 .IONS t” VENTILATING FANS &. „i'='-' .:: e.PC3RATIVE COOLERS 3 " 'El, HOOD:(PERv12 OR 12' PTN: OF HOOD) iMISCELI_ANEOUS (N07COVERED'_EL$04WIE UNLISTED GAS APPLIANCE <400,000 BTU • ULINSTED;GAS'APPUANCE5400;000 BTU `: ;' USED APPLIANCE <400,000 BTU USED;APPLIANCE '400,000 BTU. '':::>:' AIR HANDLER <10,000 CFM `AIR .NOTE MINIMUM PERMIT FEE IS $35.00 (City/State) (Zip) NUMBER OF UNITS' '•- X EACH :. -` UNIT"'',' t =AMOUNT' 'r--,.. , ., x 10.00 =.. •x 25.00"=- x10.00'_ -x12.00 ;ft t rv4; - '11.5.00!,7-12.;:::' x12.00:= x20.00 '— •,4•:.; .x25.00.-= 'X35.00:='' x 60:00 :'12.00x= ... In. om ..‘3,-„,2_6i Ca =-= .,._..< _: _ .- x'^. ,-,- =: syr i'".4r-;^. 2':•'2 =-;jx,:_ ;y; _;,6 ik:1".,, •= y�eu" :Jir-'_tiF ,, : `'ic:^, ..- - 'T ip: ,- ::•!& ;?..•::'‘.4:: •,,: ._ c;v_ . _ [.`.. ---71.:7,4;:2;-:17;',*:,...,_ _ ;f » :;;..-. -_ :- kef'' .; ,; ro?-t te-<: ;.,• t74r4t r ag * 4''sitiiy ;z '3?.r � x20.00;=4k`•,a_*: X 25:00;* °x35:00./= X 60.0071 :4 _. r:..y:31:x 'Vi J' ,4I34' w , ` :a"u^.''.::- 3' L` r a t _. i:,, k•..:'L.... moi_. r: x10.00_ -t , X_10.06:1': ' "X50.00'=I: . X 10.00' . :'ex 10.00- _ x 10.00`- x10.00 = • .10.00-=-- x 50.00 = -= x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = s.i';it .: ` '=;;w' ;:::11.: _ 1:#;_ . _- .:T:33"„-2'?,c:74.7:. ,::, «,'>x -::-.z -34,73,17..-3,i:;:".•:.:2;-'473.4:: +Af r'', tr. - ... " :.-Dirsxr: . , ;24.-J.:.:.., -: -.'..15-1:1"; w •, -- .,_ - - - —- - - SUBTOTAL $ 26'.tiO PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = S 50,0) SIGNATURE Spokane County Divis •;r: West .nn„ MrnotivrtrI,, At,rr";t\ Cr-.,,__. ,.