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1992, 08-13 Permit App: 92006405 Wood StoveMECHANICAL PERMIT APPLICATION FORM 1 /Dln(ormation Worksheet JOB STREET ADDRESS: E J L � 5 p(rf'QG P� C� ^� 1 / . CITY/STATE/ZIP: J� IPar7 P -/ II/AT !'7=046 PARCEL NUMBER: yS� ! v[ , ,d-iL3 V3 OWNER: Kr 2r� Y Q,!^Ci li du �iJP/) PHONE NUMBER: 9,2 S - 6 �y7� 8ot- Faal S a MAILING ADDRESS' E.�ll ,/Qf (1,t -r re? Ce- i 0 (Street) (City/State) CONTRACTOR: u0 (I £K LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS' S4'V'2 e - (Zip) 9c2 F -(08 yS DESCRIPTION (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODSTOVE/INSEI T'' *• .'' GAS WATER HEATER GAS EQUIPMENT;.c 00,00(1SW(INCLUDES`;:: GAS EQUIPMENT+100,000 BTU DUCTWORK) GAS PIPING..(EMDUTLE j BOILER/REFRIG 1-100M BTU 11,01.a/1.3g0.014:914,0,0::. _ BOILER/EFRIG 501-1,000M BTU BOILER/REFRIG 1 0001; 7 Z50M BTU;: `:. BOILER/REFRIG +1,750M BTU HEAT PUMP &.'Al14 CONDITIONER O -STNS HEAT PUMP & AIR CONDITIONER 3-15 TONS H EAT PUMP$& AIR COND(TJONER j5SG 10NS HEAT PUMP & AIR CONDITIONER 30-50 TONS HEAT PUMP:;'&<AIRCQND.LTION1'#.5..0;TONS VENTILATING FANS EVAPORATIVE;GQQLERS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) CLOTHES DRYER GAS LOG MISCELLANEOUS (NOT;. COVERED; ELSEWHEF UNLISTED GAS APPLIANCE <400,000 BTU ULI LASTED.G.ASAP.PLIANCE`>ti00;p00.aB USED APPLIANCE <400,000 BTU USED: APPLIANCE:4O'0r000?STU. ;:i .'I AIR HANDLER <10,000 CFM AIR HANDLER>:10 000'.:CFM :;: NOTE: MINIMUM PERMIT FEE IS $35.00 - (Zip) 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 = x 12.00 = 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 = x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x12.00 = x 15.00 = . / 0?, -5, • SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ .JQ,k" Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675