1990, 09-20 Permit App: 90004779 WoodstoveMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: c'thO 9 /V Le, `r
CITY/STATE/ZIP: e - " . S - PARCEL NUMBER:
OWNER: IA Re) n1 PHONE NUMBER: ci a - qc) .7.,
MAILING ADDRESS: aOO9 N /-0"),5GREEQACRtS i 99 bit,
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Zip)
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
.....................................................
GAS WATER HEATER
47!e,'tQ!.fi•,i,�il!4!��.7!1!Gf.`4:;1: �;4 Sl4:jYYV ;4 �:;4i.; �tt?s\J �i�il:G!�! �>�:
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501.-1,000M BTU
BOILER/REFRIG +1,750M BTU
H ' `f' l�'+tP AIR:? ONDITIONER 0 TONS>>
HEAT PUMP & AIR CONDITIONER.3-15 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
.................................................
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
M SCELLA'NEOUS �t1+QTCO ERED EkSEWI
UNLISTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
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
x 12.00 =
x 20.00 =
x25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x35.00 =
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 =
x 12.00 =
x 15.00 =
I
as bO
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
o
=$ 50 -
Spo'ane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675