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1992, 09-18 Permit App: 92007837 Wood Stove ga . --) g31 MECHANICAL PERMIT APPLICATION FORM Information Worksheet l Vgg JOB STREET ADDRESS: . \-1-V- .�.0 \-\c CITY/STATE/ZIP '�-'\tCACX Q , . , PARCEL NUMBER: OWNER:\\��.( Q.. � )•. r�PHONE NUMBER: �-'` c - l_ck_o-2--F.; MAILING ADDRESS: �{`C .0 Street) (City/State) (Zip)) ,c� CONTRACTOF�\� \c. N �' `l\c�`Q LICENSE NUMBER `y�J� ooV�\ .---,,k--- `J� �' PHONE NU BER: 5ALQA_O - kC1 aci C\R�MAILING ADDRESS - J �. ��\ `0--"s� - Lt\ , . t (Street) (City/State (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER 1 X EACH I DESCRIPTION OF UNITS UNIT = AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = W000STOVE/INSEI T ">:<'``> ':<: . .... 1111111_ x 25.00 = -CO GAS WATER HEATER x 10.00 = GAS EQUIPMENT<100,000 BTU{INCLUDES x 12.00 = GAS EQUIPMENT+100,000 BTU DUCTWORK) -- x 15.00 = GAS PIPING (EA(OUTLET) 1 x 1.00 = BOILER/REFRIG 1-100M BTU x 12.00 = :. .. .. ..... ....... BOILER/ EFRIG 101-500MBTU: `<' ` :> » ;::>.... x 20.00 = BOILER/REFRIG 501-1,000M BTU 'x 25.00 = BOICER/REE.RIG 10001...1 j50M BTU;':; x 35.00 = BOILER/REFRIG +1,750M BTU x 60.00 = HEAT PUMP&AIR CONDITIONER 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 = HEAT PUMP &AIR CONDITIONER +50 TONS x 60.00 = VENTILATING FANS x 10.00 = EVAPORATIVE COOLERS x 10.00 = ......... ..... .... TYPE I HOOD (PER 12' OR 12' PTN OF HOOD) x 50.00 = TYPE II HOOD x 10.00 = CLOTHES DRYER x 10.00 = RANGE _ x 10.00 = GAS LOG x 10.00 = MISCELLANEOUS'(NOTCOVERED ELSEWHERE -- x 10.00 = UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = ULINSTED GAS APPLIANCE>400,000 BTU x100.00 = USED APPLIANCE<40.0,000 BTU x 50.00 = USED APPLIANCE.>400 000:BTU , x100.00 = AIR HANDLER <10,000 CFM x 12.00 = AIR HANDLER>1'O,000 CFM T x 15.00 = SUBTOTAL $ cO PLUS: PROCESSING FEE + $ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT FEE DUE = $ ,- (1),CC) CT SIGNATURE \ .... 2....0(...,\ Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675