1991, 03-08 Permit App: 91000964 WoodstoveJOB STR ET rtE/ZIAIlD
e e
CITY/ST P:
OWNER:
MAILING ADD
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
.�a
DRESS: 17 3 ft i yt Way
a� _V gig 77"7f PARCEL NUMI3ER:
U/a�� H Y Gv� /da/,�dvq Trs,vWPHONE NUMBER:
N�SS:E/t323 eseEtime, C ,e eaC'COrets
(Street) (City/State)
LICENSE NUMBER:
PHONE NUMBER:
CONTRACTOR:
MAILING ADDRESS:
@cr 999/6
(Zip)
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
eft PM r,1; Ui NSW cLt3t * „
GAS EQUIPMENT+100,000 BTU DUCTWORK)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
it1E3ttea 1Ftnig-S1
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
INYA ,(0 19:00(<)TpSF
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
Mt.04 F1EOUS {(JOtTCOVEREQ E S ft:-
UNLISTED GAS APPLIANCE <400,000 BTU
111, ;S R 1p!?G.FW-417
USED APPLIANCE <400,000 BTU
WO
AIR HANDLER <10,000 CFM
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 =
.P.5 -a°
NOTE: MINIMUM PERMIT FEE IS $35.00
SUBTOTAL
PLUS: PROCESSING FEE
EQUALS: TOTAL PERMIT
FEE DUE
$
+ $ 25.00
=$
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675