1991, 09-20 Permit App: 91006126 WoodstoveMECHANICAL PERMIT APPLlCA-T' s` FORM
Informati6n Worksheet - (p
JOB STREET ADDRESS:-
CITY/STATE/ZIP: S,pL K o}fle- W,A PARCEL NUMBER: 3S4 Y.3
OWNER: b1 r Citi_ Lonnbn-l- PHONE NUMBER:
A !/
MAILING
(Street)
(City/State)
(zip)
CONTRACTOR: rO) C) G 4ref-)E)d Cf-t-Af✓z LICENSE NUMBER:
PHONE NUMBER: c �SDg) Ra(o-d'9I l
MAILING ADDRESS: 1E • q 31 D .SP 2A qu e- S ,p�f` Ait! wa 9-7:2 C)& -6146-
(Street)
GS(Street) (City/State) (zip)
.- MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
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GASP WATER HEATER
GAS EQUIPMENT+100,000 BTU DUCTWOR_
•
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}:w ":v��rrv�vn•::t� •:.•v.-h-:{v:Nl'dOP'RdvYn w.::{{v'•riMY3iA%i'r�7rrL{vv.�
BOILER/REFRIG .1-100M BTU
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BOILER/REFRIG 501-1,000M BTU:: .
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o
. ��45 ' ' � �t: h � GGdL000 IGAry
Ei
BOILEWREFRIG +1,750M BTU
.��e4:wnxhiLv��h.vri r:x :•::.L•pp�hvw V v�wauA� .Kta/kI.LJGi.:
.h HEAT PUMP $ AIR CONDITIONER 3=15TONS
HEAT PUMP &`AIR CONDITIONER 30-50 TONS _ '---
VENTILATING FANS'.
e•
'-TYPE 1
�M y
t' CLon
r
IN
P -%AQ 1
UNLISTED GAS APPLIANCE <400,000 BTU
ULI(�S'ED GAS APpLIA1�CB�400,t)b0 BTI
USED APPLIANCE <400,000 BTU
AIR HANDLER <10,000 CFM
AIRt��DLERy0;000 AFM .............. .
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
=AMOUNT
x 10.00 -
x 250 -
x 10.00 =
x 12.00
x 15.00.._;
x 1.00
x1200
x 20.00
x 35.00
x 60.00 =
x 12.00""
x 20.00 -.
x 25.00
x 35.00
x 60.00 - ..
x 10.00
x10.00
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 =
- ..,
r x
. .-.;.
r:xF
.
'�-' F . >' .ry J.'r'•`4
._ .
.
SUBTOTAL
$
PLUS: PROCESSING FEE
+$ 25.00
OTAL PERMlT
ffTFEE DUE
Spokane County Di -7-
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