1992, 10-19 Permit App: 92009069 Wood Stove I
MECHANICAL PERMIT APPLICATION FORM �' �
Information Worksheet n°\7-C1n°\7-C1""��
JOB STREET ADDRESS: S. / C)3 *. Tc_• LiS 'K CJ
CITY/STATE/ZI,nP__ tS LI? Lc Yrk- PARCEL NUMBER:
OWNER: it// • ,S PHONE NUMBER: <<:�Cc-k/I..S
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: (a ft., P'riCL LICENSE NUMBER: Lcicgi /,2/00.
PHONE NUMBER: 5,3( S)3(i)f
MAILING ADDRESS: Pu ; )1C a�J �j �Ck���ti� int `/ I ZZG
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
W
x 25.00
GAS WATER HEATER x 10.00 =
GAS 1 UIPMENT 100,000 BTU(INCLUDES :: :: x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
1.00
.OU A
x =
BOILER/REFRIG 1-100M BTU x 12.00 =
x 20.00 = •
BOILER/REFRIG 501-1,000M BTU x 25.00 =
x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
WF_AT PUMP AI CONI ITION R 0 TONS >: x 12.00 =
HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 =
NI AT f'UNt ►IR ONDITI NEI 1a S TONS x 25.00 =
HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 =
HEATPUMP&All CONDITIONER+50 TONS .`' '':'.>: `:` >: x 60.00 =
VENTILATING FANS x 10.00 =
A R.
x 10.00 =
:��
:. . . .. . . ......... ..................................... ...
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
1
x 000 =
CLOTHES DRYER x 10.00 =
x 10.00 =
GAS LOG x 10.00 =
MISCELL 1N C US(NOT COVERED ELSEWHERE x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
U:LINSTED GAS APPLIANCE>400,000 B U >:<<:: : : x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
1
USrf3 APPL1ANtCZ�4±�i��000..:TU
x100.00
AIR HANDLER<10,000 CFM x 12.00 =
Alli HANDL. �1d 004 CSM x 15.00 =
SUBTOTAL $ a 5 )
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE _$ 5l .C1
SIGNATUREa.t_F', 0,-75.
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675