1992, 07-08 Permit App: 92005067 WoodstoveJOB STREET ADDRESS:
CITY/STA/TE/ZIP: ,,/,,,
'OWNER: Ulu/rd. J ki�1LUI/MAL II
_MAILING ADDRESS' /DSI JG. $1 . C.41 a,i/pS
(Street)
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
PARCEL NUMBER:
PHONE NUMBER: q
UMJdh wJ
(City/State)
5/..5"P3 %- o7S49-3
(Zip)
• CONTRACTOR: LICENSE NUMBER:
MAILING ADDRESS:
PHONE NUMBER:
(St ) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
X w
BOILER/REFRIG 1--100M BTU
BOILER/REFRIG 501.1,000M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 3-15 TONS.
T.
iqz
- (zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
.6P�� :�'• r.
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
R
CLOTHES DRYER
raf::r
GAS LOG
MOD
WWI g
UNLISTED GAS APPUANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
AIR HANDLER <10,000 CFM
fii i a•.
NY:}:.4r.\vv: n•:::.v}� .SW 1vi•r4n
,f;
c {}}yw
moi:' a •h g
fleit
'aCvfr
•
x10.00=
x 25.00 =
x 10.00 =
x 12.00 =
x;15.00 =
x1.00 =
x12.00 =
x 20.00 =
x25.00 =
x 35.00 =
x 60.00 =
x12.00 =
x 20.00 =
x-25.00 =
x35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x'50.00 =
x 10.00 =
x 10.00
x 10.00 =
x 10.00 =
x10.00
x 50.00 =
x100.00 =
x 50.00
x100.00 =
x 12.00 =
x 15.00 =
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_$
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675