1995, 10-09 Permit App: 95008213 WoodstoveMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: / 2 S ) L
v ITY/STATE/ZIP:���-= c i'w � `��' PARCEL NUMBER:
OWNER: �S �� �' �� PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: td at? k el„,,„u� LICENSE NUMBER: /IA 'II O' S /ooK>
PHONE NUMBER: 3�-'"1.3 s
MAILING ADDRESS: ( 1) . 7-1 6v-e,.t, - 2' t'`4"51/ IA yy %/'.2-0/
(City/State) (Zip)
(Street)
MECHANICAL WORK
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
W9O0STOVE/INS
GAS WATER HEATER
GAS EQUIPMENT < 00,000 BTU INCL DES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS. PIPING (EAOUTL........>:>>N>>>...
BOILEWREFRIG 1-100M BTU
BOILER/REFRIG 501 -1,000M -BTU
....................................
BOIR!REtooaM>�..:..::....v...:
BOILER/REFRIG +1,750M BTU •
HEAT PUMP a AIR CONDtT10NER D 3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP 8 AIR CONDITIONER 1:5.30 TON
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP B�.AIR CONDITIONER +50 TONS .:
VENTILATING FANS
EVAPORATIVE OOL
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
..............................
TYPE iHOOD
CLOTHESDRYER::.::.:::...................:.............................................
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 >400,900 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER'>10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE L' -z 6-4- tPek �1?
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x10.00 =
x 25.00
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x35.00 =
x60.00 =
x 12.00 =.
x 20.00 =
x 25.00 =
x 35.00 =
x60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
I
-.
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x50.00 =
x1(0.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$ ,.r. `y)
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_ $ .`5"7). ov
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675