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1993, 11-02 Permit App: 93010514 Wood Stove45-4' / /tzc-e MECHANICAL PERMIT APPLICATION FORM /� Information Worksheet JOB STREET ADDRESS: ie /c S F4 CO AJ CITY/STATE/ZIP: S P©(y [41/9 PARCEL NUMBER: OWNER: (2-IGty &c VQ( -2: PHONE NUMBER: GJ - 7'1305 MAILING ADDRESS: 5' 0,11I (Street) (City/State) (Zip) CONTRACTOR: 41197J0/u/t C/f'/f101/!%G/ LICENSE NUMBER: /VJ-) /OCS /00,K9 _ PHONE NUMBER: 922 7000 MAILING ADDRESS: /% 7b/6 6/lc9-vj0tit,+ 5,09 ✓/jjry- 992( Z. (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE , DESCRIPTION . • ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODSTOVE/1NSERT GAS WATER HEATER GAS EQUIPMENT <100,000_BTU (INCLUDES GAS EQUIPMENT+100,000 BTU DUCTWORK) GAS 'PIPING. EA OUTLE BOILER/REFRIG 1-100M BTU BOILER/REFRIG101'=500M BTU • BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG 1,000-1,750M BTU BOILER/REFRIG +1,750M BTU HEAT PUMP & AIR,COND,ITIONER:0-3 TONS:' HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT -PUMP,& AIR:CONDITIONER:15+30TONS._ i°: HEAT PUMP & AIR CONDITIONER 30-50 TONS HEAT: PUMP & AIR CONDITIONER +50 TONS VENTILATING FANS :EVAPORATIVE COOLERS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) CLOTHES DRYER RANGE GAS LOG MISCELLANEOUS (Not`COVERED ELSEWHERE UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED GAS APPLIANCE >400,000 BTU USED APPLIANCE <400,000 BTU USED. APPLIANCE >400,000 BTU AIR HANDLER <10,000 CFM AIR HANDLER>10,000'CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x25.00 = x 10.00 = x 12.00 = x 15.00 = x 1.00 = x 12.00 = x 20.00 = 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 = x 10.00 = x 50.00 = x100.00 = x50.00 = ..' x100.00 = x 12.00 = x 15.00 = -/- _ _'5,-- ' SUBTOTAL $ ZS, - ,,- PLUS: PLUS: PROCESSING FEE +$ 25.00 EQUALS: TOTAL PERMIT FEE DUE _ _$ 50 ,- Sp•` ane County Division of Building's West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675