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1993, 03-23 Permit App: 93001694 Stove, PipingMECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: 193/1 CITY/STATE/ZIP: C6 P `UC ,eg r tAk? PARCEL NUMBER: OWNER: (2) 1,=& C PHONE NUMBER: MAILING ADDRESS: SO/i' (Street) (City/State) (Zip) CONTRACTOR: L, e4 V/5'/ 7 LICENSE NUMBER: L,�-`,//'/PC/_ / Di"✓/ PHONE NUMBER: MAILING ADDRESS: L l A'i ) % /3C) wci (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) ......................................................................................................................................... WOODSTOVEIJNSEfT.: >` ......: GAS WATER HEATER GAS EQUIPMENT <100,000 BTU (INCLUDES GAS EQUIPMENT+100,000 BTU DUCTWORK) GAS PIPING (EA OUTLET) < `: BOILER/REFRIG 1-100M BTU BOILERIREFf1G.101...500M BTU . BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG 1,0001: 1,750M BTU BOILER/REFRIG +1,750M BTU ........................................ . HEAT PUMP & AIR CONDITIONER 0-3 TONS... . HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT PUMP & AIR CONDITIONER 15 30 TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS HEAT PUMP & AIR CONDITIONER +50 TONS VENTILATING FANS EVAPORATIVE COOLERS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPE II HOOD CLOTHES DRYER 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 >400,000; BTU AIR HANDLER <10,000 CFM AIR HANDLER >101000 CFM '' NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x 10.00 = x12.00 = x 15.00 = / x 1.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x60.00 = 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 = x10.00 = x 50.00 = x100.00 - /, 0O t /O,n n x 50.00 • x100.00 - x 12.00 - x 15.00 - SUBTOTAL $ //. 0 0 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ 36- O (0/O Spokane County Division of Buildings West 4106 Broadway Avenue Spokane, WA 99260 (509) 456-3675