1992, 11-02 Permit App: 92009624 Wood StoveMECHANICAL PERMIT APPLICATION FORM � � _9 Q0
J Information Work� / t
JOB STREET ADDR SS: /ICS i"`fi J�a'� �=;
CITY/STAT IP h PARCEL NUMBER:
OWNER: L PHONE NUMBER:�.�rt �% 7 - O
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
;#N tl.....................................:.:::.::.::.::.:.:::.::................:.;;:.;:«.;:.;:.:
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
.::......:...:....:...:...:...:....:....:....:....:...::..:.............:.......:...:........:::.......:.......:..........:.................
VENTILATING FANS
TYPE i HOOD (PER 12' OR 12' PTN. OF HOOD)
.............................................................................................................:..
CLOTHES�DRYER�:.�::::...................................................................................
GAS LOG
UNLISTED GAS APPLIANCE <400,000 BTU
R11......'ifC A&r,I�I:I1....0 .......Gt►...
USED APPLIANCE <400,000 BTU
........::.:.;:.;::.;:;.;:.:
AIR HANDLER <10,000 CFM
NOTE:
SIGNAT
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 =
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 =
.9S',,00
SUBTOTAL
$
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
1=$ .S6 av
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675