1991, 05-02 Permit App: 91002277 Woodstove GarageMECHANICAL PERMIT APPLICATION FORM
J Information Worksheet
/�
JOB STREET ADDRESS: /"( 0 2 n r di;54
CITY/STATE/ZIP:% S C(/U, PARCEL NUMBER:
OWNER: %i�? o o a . Oft a no PHONE NUMBER: 7i 7- 7.57 L o r S3 c/-tss`4<.i-
MAILING ADDRESS: S a v t - /cc -
(Street)
CONTRACTOR: CD Ce 1A...° r
(City/State)
LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(ZiP)
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
• i nv����4����i�^n�\:Ki'�•'A3tYnvirin4::v:i4!c-:i-h3:.:.v:.i•?:: is vfh"v:Iv:
BOILER/REFRIG 501-1,000M BTU
t11:3>=G s0?1`=�50MD`:t`t
BOILER/REFRIG +1,750M BTU
.................:Y���a?-:.mow;ia -..... ... .- .......... .........
' HEAT PUMP &AIR CONDITIONER 3-15 TONS
A '}p(JMp AfRCOND(_TIONER;.1 30_TONS..x
HEAT PUMP & AIR CONDITIONER 30-50 TONS •
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
• CLOTHES DRYER
GAS LOG
iWc:=:.iv.:vr-. '. W Kvv4bv}.:.i• •Ivvv::i::3.•fi}:.i:•}:<:vv:::.�:s-::'4.vv+v+.vnimmvv:CyY.Mv:vv:?:•:}}i.?i•:•t':: i•::v..
• UNLISTED GAS APPLIANCE <400,000 BTU
c3NMAINA
USED APPLIANCE .<400',000
4{>ry00,,0±0•:.•:0.::�-:}::..�./:[.:�!.!.i}.}..::'N�'L3>S'::v'XvMUy::..e:?Y•:>9'<ary::.'.<i`}::r�ii?.i3:::•<.x:>•x:<:v:�=F ::.in.:i«3?}f::`�•F:3�'.'
BTU
AIR HANDLER <10,000 CFM •
::.l:iviihvGiv::ri::�nx :: �:•::.w.:•:<.`+::.....::r ��S-::.
NOTE MINIMUM PERMIT FEE IS $35.00
(zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x10.00 =
x 12.00 =
x 15.00 =•
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x35.00 =
x 60.00 =
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 =
x 50.00 =
x100.00 =
x12.00 =
x 15.00 =
X.
'
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Sookane. WA 99260 (509) 456-3675