1992, 12-15 Permit App: 92010938 Wood Stovey-5 l (02s it -03 et,2 1 CD9 3
L-'3 MECHANICAL PERMIT APPLICATION FORM
inj<Z+1y-n 6-5 Information Worksheet
JOB STREET ADDRESS: _E._ - I I coca VirlA )(Lkie �I ' 7
CITY/STATE/ZIP: SptY-ftno t 0uGt cigd()(a PARCEL NUMBER:
OW) l,Jr\atG"- qa(PHONE NUMBER: / n - cT /p
0
MAILING ADDRESS:
r (Street) (City/State) (Lip)
CONTRACTOR: t fi i C ri (1 PJ i oP ;,I CE;jr FlQ LICENSE NUMBER: (----4 IC.0 610, I i.3 G L(
1-1
PHONE NUMBER: (SOO) (7,_?(..- -�' i / I
MAILING ADDRESS: l- • (l -%17 -5.7K (=irILci•,"' ,-1/.;P l.:.i.-i
(Street) _ r (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE ._.F
_DESCRIPTION
• ELECTRICIDUCTWORK(SEPARATE SYSTEMS):.. ,
V✓OODSTOVE/fNSERT
GAS WATER HEATER
:GAS EQUIP1SiENT<100;000 i3TU (INCLUDES:; -
GAS EQUIPMENT+100,000 BTU DUCTWORK)
:GAS PIPING (EA OUTLE)-
BOILER/REFRIG 1-100M BTU
Fri O!L_R/9EFRIu_'!01-500METU
EOILER/REFRIG 501-1,000M BTU ----- _---.----
EUiL•=i�wiFcFRIGYi"u't?G"
SO!LER/REFR!G +1,750M BTU ' . -
`EAT, RUMP &'AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS ---
HEAT;PUMP::& AIR :CONDITIQNER:15-30=TONS'
HEAT PUMP & AIR CONDITIONER 30-50 TONS - -
HEAT PUMP & AIR:CONDITIONER_+50_TON S,_:
VENTILATING FANS . -. -
EVAPORATIVE COOLERS,..:::::-;{ _- -•-
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
:TYPE IT HOOD',
CLOTHES DRYER
GAS LOG
MISCELLANEOUS COVERED: ELSEWHERE:
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED:GAS APPL!RNC'c>=:00:Gi70 d7 -ii
USED APPLIANCE <400,000 BTU
USED APPLIANCE>400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER.>10;000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
NUMBER
OF UNITS
X EACH
UNIT i,
= AMOUNT
'
`.210.00 =
)
x25.00 =
X 'MOO =
X 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x20.00 =,
x 25.00 =
x 25.00 =-
x 60.00 =
x12.00 =-
x 20.00 =
x25.00 =
x.35.00=
x60.00 =
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
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
-25. Z31
�^
- -
SUBTOTAL
g Qcy CO
PLUS: PROCESSING FEE
+S 25.00
EQUALS: TOTAL PERMIT
FEE DUE
o -a
= S 50 ✓
SIGNATURE
Spokane County Division of Buildings