1994, 09-06 Permit App: 94008628 WoodstoveMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS:
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: t }l PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Lip)
Q
CONTRACTOR: ������'� ��tt� �Q t%,-� LICENSE NUMBER:
PHONE NUMBER: .�� �° -'� 38�
MAILING ADDR
(Street)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
IlV' ,:..'DT...V<>~»><<=<<<<>»<><>><<
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
...................................
......
...........................................................................................................................................
E.
GAS PIPING FA OUTL ..::...._.
..........:... .:.... .
BO_ ILER/REFRIG 1-100M BTU
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
HEAT PUMP AIR CONDITIONER+50 TOMS `< ....
VENTILATING FANS
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE '�� f
V/
(zip)
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
$ a._T
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_ $G
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675