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1990, 10-08 Permit App: 90005202 Woodstove
MECHANICAL PERMIT APPLICATION FORM Infformation Worksheet JOB STREET ADDRESS: ./7 /— • , 5 4 /, I r CITY/STATE/ZIP:4'ti a('4He I�JA 99z/'z PARCEL NUMBER: 0-3 G (_ /L � ( OWNER: 41,;.1 "`L-O/Pt/�f9. MAILING ADDRESS: 5//? E. S4`` CONTRACTOR: ' PHONE NUMBER: (Street) (City/State) (Zip) LICENSE NUMBER: PHONE. NUMBER: MAILING., ADDRESS: .(Street). (City/State) (Zip) MECHANICAL WORKSHEET/FEFs+$CHEDULE . •-_ spa; NUMBER. ' X EACH '° OF''UNITS .. UNIT = AMOUNT ..ae r• x$10.00 = a 5'-,x„25,. 00.= tiu‘% • 1.a"10.00 %_ ri,, ;, x" :tF 12"'.0 0 4 . c 15.,.,0b0 { �00 r 12k.00 = X4'20'400.1%=, E 425'''00. X 1 3 5 :O''O Xf60s00 ? xt12 0o' x2„00.00°,rr f00.4,4 x35: ,00T x* 60t 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 = NI' Y,I4t99�� T-. fl 3g:9g S • TYPEF`DHOOD:' PER't 12 �; TYEE1*Xr+H00,D4r CLOTHES* DRYER * r _ < t RANGEakk`' M.yz�, _ �� .i GAS LOG ::- . F MISCELLANEOUS,,,(NOT`COVERED ELSEWHERE) UNLISTED„GAS., APPLIANCE <400, 000. BTU UNLISTED(GAS; APPLIANCE'>400,000•BTU s' , USED,APPLIANCEu'<400,000 BTU ' USED'APPLIANCE?>4Odt,000;BTUrH AIR HANDLER2<10,000 CFM AIR HANDLER'>10;000 CFM tCONqIINER0 3,'' -TON TS E0 1I ITII0NE. �3 ;1514t9NSs��` CQN 7IONE -30 ` ?•�JS ,Gbgg70N 30n2O. TON`s ITAONE Y50. TO xS y yi NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE SUBTOTAL PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ Spokane County Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675