1994, 10-07 Permit App: 94009962 Woodstove45/33. 1 Zo3
qt- 5k L -7-g)
JOB STREET
MECHANICAL 0ERW APPLICATION FORM
Information Worksheet
CIN/STATE/ZIP: k L0 CA^ 99ck3'7 PARCEL NUMBER:
OWNER: ria-rk- Az':&S PHONE NUMBER:_ y '3 e7
MAILING ADDRESS:
1 (Street) (City/State) (Zip)
CONTRACTOR: �Ga�� C>` �1�. LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDR
DESCRIPTION
W -?%
(Street)
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
............
WO DSTOV INSEa1">:>:;<::::>>>:<:<»>:>:......:::>>:::>>:>
:
...:...::::........ ......:..................
GAS WATER HEATER
GAS EQUIPMENT 4100000 BTU.�INCLUOES--....;>';:'�:
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
O .
BOILER/REFRIG
... ;ill .. .............
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00
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
$r
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_ $ JZ• '1z
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675