1992, 10-08 Permit App: 92008484 WoodstoveMECHANICAL PERMIT APPLICATION FORM
Information Worksheet n n C'�- ,(
64.)
JOB STREET ADDRESS:I'JO 2 / . t •f . C���
CITY/STATE/ZIP: V! =' - ., - n 37 PARCEL NUMBER: S'S:, Y )3
Oo4
OWNER:
MAILING ADDRESS:
CONTRACTOR:
PHONE NUMBER:
-��
MAILING ADDRESS:
(City/State) (Zip)
LICENSE NUMBER: AJ -413 sio-0
PHONE NUMBER: 3-24 -73 g�'
DESCRIPTION
(Street)
ks�.0 ( •F9.2o �
(f'ty/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSER`I'
GAS WATER HEATER
GAS EQUIPMENT <100,000 BTU (INCLUDES <:
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIO 10 500M
BOILER/REFRIG 501-1,000M BTU
BOILERIAEFi IQ 1,0001-1:,750M
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONS
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 ONS
VENTILATING FANS
.................
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT; COVERED:; ELSEWHERE.
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS; APPLIANCE>400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE>40.0,000BTU
AIR HANDLER <10,000 CFM
AIR HANDLER>10,000 CFM;;
NOTE: MINIMUM PERMIT FEE IS $35.00
1
SIGNATURE
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
x20.00
x 25.00
x 35.00
x 60.00
x12.00
x 20.00
x 25.00
x 35.00
x60.00
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
=
-
-
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
_
=
=
=
=
=
=
=
/
2- o -Q
•
SUBTOTAL
$ ,2S-:03
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 61). 93
•
Spokane County Division of Buildings
West 1303 Broadway Avenue Snnkane WA QQ2Rn 4Ra-(4a7c