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