1993, 06-21 Permit App: 93004891 WoodstovetCurtut,463,0 ?"41- Add
L 6 I? MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: I c-1 30c1 s+a&Q -
CITY/STATE/ZIP: 1)-e-kocd4,,s4 , wa- `190 3? PARCEL NUMBER: y5 2-(a 2 . 3 3
OWNER: , PHONE NUMBER: 47../ - 0133
MAILING ADDRESS:
(Street)
CONTRACTOR: F-14 I C ; C./ !� is t>5 �� C_ f,J
MAILING ADDRESS: C • '131 (? :3,0 K?,fi rift. E'.
(Street)
(City/State) (Zip)
LICENSE NUMBER: i �=+ I -C (, 0. i i3 L L&
PHONE NUMBER: (25 -Ciel)
MECHANICAL WORK
DESCRIPTION
ELECTRIC/D OIWORK (SEPARATE SYSTEMS)
WOODSTOVE/IHSER _
GAS WATER HEATER
GAS EQUIPMENT <100,000 BTU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET
BOILER/REFRIG 1-100M BTU
EOIi EP/REFRIGr. 101 500M;B `U
BOILER/REFRIG 501-1,000M BTU
L L. rci R''FFi G ,0031 t 7, OM ET
BOILER/REFRIG -
?EAT PUMP..& AIR CONDI t TONER 0=3 TONS
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
EVAPORATIVE; COOLER;
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II FOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE-
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE>400000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000: BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000.:CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
(City/State)
c/9 L-' ,
PP)
-NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
is -10.30 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
'x1.00 =
x 12.00 =
x 20.00 = ..
x25.00 =
x 35.00 =
x60.00 =
x12.00 =-
x 20.00 =
x25.00 =
x35.00 =
x 60.00 =
x 10.00 =
x10.00 =
x 50.00 =
x10.00=
x 10.00 =
x 10.00 =
x10.00 =
x 16.00 =
x 50.00 =
x100.00
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
' 1
05 00
._. -.
_.
,
SUBTOTAL
$ ,Q5 --u
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= S �Ooo
SIGNATURE
Spokane County Division of Buildings