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