1991, 11-26 Permit App: 91008234 Woodstove2
MECHANi P#qAPPL]ICAmoN FORM
tnfoi'in�ton Wor�heet�
JOB STREET ADDRESS: %O Am 7"'-tn, s
CITY/STATE/ZIP: -1i S (�tl �r�c�'� PARCEL NUMBER: S� �-
OWNER: /� f / .5 � dl^Aq If Y' PHONE NUMBER:
MAILING ADDRESS: Q• %
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
...........................................................................................................................................
4QD3f0....IfISE'..........................................................._.._ .._...-....
GAS WATER HEATER :..::::........... ......... .........................
..........................
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
::::::::::::::::::...:.x'%i:4iii::4iiiiiii:!Sivi:{iSA: i'v,is4...........................................: is i.. ii:{i iiiiii:•: i::ni:� :•::•'::
GAS LOG
1�G�t.l��►�5 (�t�'�C�3�ti=p_i�t.S�W�it...
UNLISTED GAS APPLIANCE <400,000 BTU
USED. APPLIANCE <400,000 BTU
..:...
4.
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
=AMOUNT
x 10.00 =
X 25.00 a
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00
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 =
x 10.00 =
x 50.00 =
X100.00 =
x 50.00 =
x100.00 -
x 12.00 =
x 15.00 =
SUBTOTAL
$
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675