1992, 11-18 Permit App: 92010172 Wood Stove MECHANICAL PERMIT APPLICATION FORM \O CY
Information Worksheet �^
JOB STREET ADDRESS:` � /L4_I 7 114-V
CITY/STATE/ZIP: .) --A 0x d ��� , (.uc& D 37 PARCEL NUMBER:
OWNER: CJAVX)l IbI PHONE NUMBER: 9a0 ' /09
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: E ) CCFi.i}rv2 LICENSE NUMBER: 14 is-C' !/C, I %31 Lk
PHONE NUMBER: (Scci c ?(� <'%/ /
MAILING ADDRESS: F . 13 I C) 33 h HDLs_ 992 C(c
(Street) (City/State) (Zip)
._ MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
WOODSTOVEJINSER, x 25.00 = .25
GAS WATER HEATER x 10.00 =
GAEQUIPM
SENT<100 000 BTU NCLUDES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING(EA QUTL .: :: x 1.00 =
. BOILER/REFRIG 1-100M BTU x 12.00 =
t�Cala 3"R�RR{^ ll, r0�' ?� x 20.00
BOILER/REFRIG 501-1,000M BTU _ - x 25.00 =
BOILERIREFRIG , 00 ,750M 8 x 35.00 = . .. ,.:,. _ •
SO!LER/REFRIG+1,750M BTU --- ---- _. - x 60.00 =
uc .3.?�UMP AIR CONDITIONER D-3 TONS x 12.00 =-
HEAT PUMP &AIR CONDITIONER 3-15 TONS- • x 20.00 =
HEAT PUMP&AIR CONDITIONER 1 30 TONS x 25.00 =
HEAT PUMP&AIR CONDITIONER 30-50 TONS -- x 35.00 =
x 60.00 =
VENTILATING FANS .- x 10.00 =
EYP
ORA�IV=: �
OLER .',. ' `{ <` : > >< ` '` >
x 10.00 -
TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD) • x 50.00 =
TYPE !I HOOD x 10.00 =
CLOTHES DRYER x 10.00 =
RANG-� x 10.00 =
GAS LOG x 10.00 =
MIScEL� ANA'S(NO nU oc E e x 10.00 =
t ..... 0 D...;:..J �'...R.. .
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTED GAS APPLIANCE>400,000 BT U' x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
USED APPLIANCE>400,000 BTU - x100.00=
AIR HANDLER<10,000 CFM x 12.00 =
A{R HANDLER>10,000 CFM x 15.00 =
SUBTOTAL $ aS-D-0
•PLUS: PROCESSING FEE +$ 25.00
NOTE MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE _$
SIGNATURE
Spokane County Division of Buildings