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1993, 01-19 Permit App: 93000246 WoodstoveLI_ 5 MECHANICAL PERMIT APPLICATION FORM � / r` -j Information Worksheet JOB STREET ADDRESS: V 1 (o ).--ohn Rck CITY/STATE/ZIP:Y'P_DYVI.CX e S1\14 I %t5((D OWNER: Cf DY1YvL MAILING ADDRESS: 1 ( Lr , d. (Street) CONTRACTOR: PARCEL NUMBER: / PHONE NUMBER: .9ac - Li 199na s� (City/State) LICENSE NUMBER: j PHONE NUMBER: MAILING ADDRESS: • all -0 X1 � `r-'�06 ra-c'IUm c-V3-a4c. i�z3 DESCRIPTION treet) (City/State) baa -6? -z) 1d[016 (zip) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) • GAS WATER HEATER • :}�,•►{��� 4 }]l' ' qr :y::: .+{:K+}y� vl f'U •H:::.fr vn.� f .. }}7}ke".h?8:M•.yVfnnf�/.,/�1nTj�� R. NUMBER OF UNITS GAS EQUIPMENT +100,000 BTU DUCTWORK) BOILER/REFRIG 1-100M BTU B_OILER/REFRIG 501-1,000M BTU }�#y: ••�''�:«��+'.:'uaKrvuri::n• �°�yf�av�: �^yv vs .�.,:.Mt:.a•:,:.,...z•.: ,.fi,.oc Nca.,},..::{•.,{�a:7.:d:.wA., BOILER/REFRIG +1,750M BTU n64g0:arn• R.{. :i•}.{v :p { Ni:Vt:fm$A. HEAT PUMP. &`AIR CONDITIONER 3-15 TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS VENTILATING FANS RAMPOINC.0$15,2114 TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) CLOTHES DRYER. �•,h:aa• V• GAS LOG +ry..a'::v;,,. �y.::.r..•.vr.:xu ..w:,{y7yv,+ xr UNLISTED GAS APPLIANCE <400,000 BTU f xpau.}}•rci .v}vyxvu. •q•:.•: �•s. USED APPLIANCE <400,000 BTU AIR HANDLER <10,000 CFM X EACH UNIT x 10.00 x25.00 = x 10.00 X_12.001 x'15.00 x 1.00 = x 12.00 = x 20.00 -= x25.00 = x 35.00 x 60.00 = x1200;;= x20.00'" x!25.00 x 35.00 = x60.00:; = x 10.00 = x'10.00'= x50.00= x10.00 = x10.00'= x 10.00 '= x 10.00 = x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00'=_ x 12.00 = x 15.00 = (zip) = AMOUNT NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE \�J SUBTOTAL PLUS: PROCESSING FEE EQUALS: TOTAL PERMIT FEE DUE +$ 25.00 okane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675