1993, 01-05 Permit App: 92011048 WoodstoveMECHANICAL PERMIT APPLICATION FORM
Info.cmation Works eeeet
JOB STREET ADDRESS: �- /� • >�� � �-�i ��'��/
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CITY/STATE/ZIP:
OWNER: b fCc' Y +r
MAILING ADDRESS: ,c'C+c%i
CONTRACTOR: /-\i"-/ `,'1/0 l c=
\D'A'
PARCEL NUMBER:
PHONE NUMBER: e( -h -1-62q6-0
(Street)
MAILING ADDRESS: L , C%Q, 6 /PEA;
7`
DESCRIPTION
(Street)
(City/State) (Zip)
LICENSE NUMBER: Z 6) �' 'IA cr / L\ yI
PHONE NUMBER:
-575)r-.4-6/71 LL )q
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOOOSTOVE/INSERT
GAS WATER HEATER
GAS EQUIPMENT;<100000 BTU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS<PIPING (EA OUTL
........::...:::.:.:.::::::..
BOILER/REFRIG 1-100M BTU
SOILEI /REFRIG 101 500M BTU
. ....:..........:...:
BOILER/REFRIG 501-1,000M BTU
;BOILER/REFRIG 1,0001 1,750M BTU
BOILER/REFRIG +1,750M BTU
:;HEAT PUMP.:& AIR;;CONDITIONER 040'7
HEAT PUMP & AIR CONDITIONER 3-15 TONS
:HEAT PUMP & AIR CONDITIONER 15 30 TONS:
HEAT PUMP & AIR CONDITIONER 30-50 TONS
:HEAT PUMP & AIR CONDITIONER +50 TONS:
VENTILATING FANS
VAPORATIVE COLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
:MISCELLANEOUS (NOT COVERED ELSEWHEI
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTEDGAS APPLIANCE>400,000`BTU'
USED APPLIANCE <400,000 BTU
•USED APPLIANCE>400 000 BTU
AIR HANDLER <10,000 CFM
AIR.HANDLEF >10000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
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SIGNATURE /-471:f
(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 =
x25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x10.00 =
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 =
I
,,?5; C0
SUBTOTAL
$ .0 4
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ -50. CC
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675