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1991, 11-19 Permit App: 91008005 Woodstove„Acsk MECHANICAL PERMIT APPLICATION FORM \ Information Worksheet JOB STREET AD►+RESS: E • \LW C)V-•s'NO. \*Ci CITY/STATE/ZIP, 1111:�\ ,_ ` , • 101\ (R. PARCEL NUMBER: OWNER .� c S`,� T PHONE NUMBER: l\r, , --C\ Z�DN MAILING ADDRESS: c -N.., (Street) (City/State) (Zip) CONTRACTOR :F\j c Q '(\)\C_tICENSE NUMBER: S iPB Z_ PHONE NUMBER: \--\__C .0 - 1��7 MAILING ADDRESS: • 33� \V\�J`QY1 . v �.\ ?C (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE wo5 O,L e c..ic (S/ 7, DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WO D.._ OVE/I ....:...;..... , GAS WATER HEATER GAS EQU.IP.MENT <1001000 BTU (INCLI3i?:>*5 ;;> GAS EQUIPMENT +100,000 BTU DUCTWORK) G S> U ..P..P..NG �A..... ...L .. BOILER/REFRIG 1-100M BTU BOILER/REFRIG 501-1,000M BTU ER/:R.EFRIG.1 Q0 31'r:1'750M BTU»» .:•.. > <>> BOILER/REFRIG +1,750M BTU HEAT PUMP & AIR CONDITIONE t: 0-3 TONS;::'::: HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS EAT PUMP &AIR ONDITION 5:0:TONS VENTILATING FANS ...................................................................................................................... EV- PO ATIVE.. OLER TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPE (HOOD .............................................................................................................. .............................................................................................................. CLOTHES DRYER RAN„.. .:... ; E MISCELLANEOUS<(NOTCOVERED ELSEWHEF UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED GAS APPLI•ANCE>400,000BTU USED APPLIANCE <400,000 BTU USED APPLIANCE,>400,000 BTU AIR HANDLER <10,000 CFM AIR HANDLER >1.0,000:CFM NOTE: MINIMUM PERMIT FEE IS $35.00 • NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x 10.00 = x 12.00 = x 15.00 = x1.00 = 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 = 'Fa.CO ' SUBTOTAL $ , Y PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE _$ L-'6- CO SIGNATOR Spokane County Division of Buildings