1991, 12-23 Permit App: 91008753 WoodstoveMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB.STREET ADDRESS: 5.3 ?-6 Lo. - �k4.. .... . .
CITY/STATE/ZIP: 4oki4--.e- PARCEL NUMBER:
OWNER: INA4114,• 4,-.100-v\ PHONE NUMBER: 7-2_-' C
MAILING ADDRESS: 5, 3 (o Z5 d2 .=1 .042
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
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*GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
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BOILER/REFRIG 1-100M BTU
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BOILER/REFRIG 501-1,000M BTU
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BOILER/REFRIG"+1,750M BTU
HEAT PUMP & AIR CONDITIONER 3-15 TONS
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HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
WPW
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GAS LOG
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UNUSTED GAS APPUANCE <400,000 BTU
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USED APPLIANCE <400,000 BTU
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AIR HANDLER <10,000 CFM
NOTE MINIMUM PERMIT FEE IS $35.00
(zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
P Q U II D b U U O Q Q U u U A u 11 H H a N N II a N N U a p O III
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X X X X X X X, X X X X X X X X X X' X x X x X X X X X X rt X X
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675