1994, 02-01 Permit App: 94000785 Woodstove4522, i4cg f
DWI -err
L. MECHANICAL PERMI11PPLICATION FORM
Information Worksheet
14 bt
JOB STREET ADDRESS: �• /3,24 ( n -U'fr)
q4 . r g5
CITY/STATE/ZIP: itJJ, (A Qfit PARCEL NUMBER:
OWNER: j'7�� ) Mi ti PHONE NUMBER: '%'L� -535
`j'�,nr►'�!?�1 �,...
MAILING ADDRESS:
CONTRACTOR: iti
MAILING ADDRESS: W 1
DESCRIPTION
(Street)
MECHANICAL WORK
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVEIINSERT_
GAS WATER HEATER
GAS EQUIPMENT 1O0, 0 Tl '
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET)
E3OILER/REFRIG 1-100M BTU
E30ILER/REFRIG'1c1-ocM�T�isH`"th
E3OILER/REFRIG 501-1,000M BTU
BOILERIREFRIOa , ?QQ 7, SQM :t T•U•fi,
E:OILER/REFRIG +1,750M BTU
E-1 EAT PUMP
,& AIR OONDITI ..,... O
EAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP AIR CONDITIONED 1`5-30 T(
HEAT PUMP& & AIR CONDITIONER 30-50 TONS
HEAT PUMP: &All CONI ITION Aa+5.Q.
VENTILATING FANS
EVAPORATIVE COOLEF
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
.......:..............................
................. .
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS`,(NOT'COVEREQ I LSi�WHE:
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANC.
USED APPLIANCE <400,000 BTU
USED APPLIANCE 400,000 J
AIR HANDLER <10,000 CFM
AIR HANDLER>10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(City/State) (Zip)
LICENSE NUMBER:_ /JI')"T)ia Jai
PHONE UMBER: 3a--7 e8 ?Q,
( itylState) (Zip)
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 =
x35.00 =
x 60.00 =
x 10.00 =
x10.00 =
x 50.00 =
x10.00=
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
2--s-: zi�
-----_��.
_________
x 12.00 =
x 15.00 =
SUBTOTAL
$ �, Q
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