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1991, 07-03 Permit App: 91003981 Inspect Wood Stove MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: / 90/ Z t, .j 14 (/e/ 4 V CITY/STATE/ZIP: lirpeci ccv- PS A✓'. 990/4. PARCELNUMBER: OWNER: 14/ r e rc b er PHONE NUMBER: 5 3 5 07 4 q MAILING ADDRESS: e .36 // /9 tti :frka..,Ar 99e z 3 (Street) (City/State) (Zip) CONTRACTOR: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = W'OD .T VE/( ,..::E T >•== >'< >< >>= > > <> >< > >N< » '=>=< EM x 25.00 = GAS WATER HEATER x 10.00 = GAS QU gaga ' +dntOW NC .9I:)= >:::<:>:::::;::»::>;_;::::;:_:: x 12.00 GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = GAS PIPING(EA OUTLET) x 1.00 = BOILER/REFRIG 1-100M BTU x 12.00 = BOILER/REFRIG 501-1,000M BTU x 25.00 = ::B.. L-::RMIE_F<:,.Iai:T >00 ._ ,750M BT _- _::::i�:::r :::: :i*Kr* ::it = 01LERIRI=1=1.2tG � 0001 7,75bM BTC .,..:.:.:.....:... . : .... :.::..:.;:.; x35.00 BOILER/REFRIG +1,750M BTU x 60.00 = HEAT PUMP&.AIR:CONDITION:EP 0 3 TONS x 12.00 = HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 = HEAT PUMP&AIR CONDITIONER 15:30 TONS x 25.00 = HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 = - lig = EA'ii'DUMP�AIR CONDITfC3NBl�+50 T©NS:,:;-,-.::_::..:;.;::.::;;-: x 60.00 VENTILATING FANS . x 10.00 = EVA ORA .V, __CO:>.:.:_:ERSmi;:.moi-ii < >< >=>< >`> < == >'<< « = dl�A�tV#=GC�C.ERS ,;. x 10.00 TYPE 1 HOOD(PER 12' OR 12' PTN. OF HOOD) x 50.00 = TYP..:E II x 10.00 = ....__..._....00_ .:. CLOTHES DRYER:.:::::.........._._...._......_.............-.__............. x 10.00 = RANGE x 10.00 = GAS LOG x 10.00 = MISCELLANEOUS(NOT COVERED ELSEWHERE x 10.00 = UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = ULINSTED:GAS APPLIANCE>400,000 BTU x100.00= USED APPLIANCE<400,000 BTU x 50.00 = USED APPLIANCE>400,000 BTU xl 00.00= AIR HANDLER<10,000 CFM x 12.00 = AIR HANDLER>10,000 CFM x 15.00 = SUBTOTAL $ PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT FEE DUE _ $ SIGNATURE Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675