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1991, 06-28 Permit App: 91003852 Wood Stove MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: 77 /L " f� �[ _ ,!�Q6 CITY/STATE/ZIP: � Co< L� i 9 � PARCEL NUMBER: '21)57 )E OWNER: C�i -D,r 1l" Z-2G//E/14 PHONE NUMBER: l `Z - j MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = ERT = x 25.00 GAS WATER HEATER x 10.00 = GAS: 01404 1O.,;,..04[OT .<` NCL.:'DEQ.._ «''<>> >>= x 12.00 = GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = GAS PIPING(EA OUTLET) x 1.00 = BOILER/REFRIG 1-100M BTU x 12.00 = QIL IR. aIG IO1- 50OM ETIJ:_.:::: x 20.00 BOILER/REFRIG 501-1,000M BTU x 25.00 = ;>;0..)_ 3I .:<.: G. ;U043_>:>.):= 0;; BTC::::-::-::.;:»;::;::::;::-:;»»:_>:-:;>:__::>:: 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...8$AIR:CONDITIONER15=30TQNS .:._: x 25.00 = HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 = HEAD ;: -.;_ _<::_ .:: < ; _.: >:,;..:_ 0 ". <><<_><_><<>> = >PllMPc AtR C4t�1'I`�ONER t50 Tt)1�tS - --:.:..... -x 60.00 VENTILATING FANS x 10.00 = x 10.00 = TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 = TYPE:11 OOD x 10.00 = CLOTHES DRYER x 10.00 = RANGE. .. ;: x 10.00 = GAS LOG x 10.00 = MISCELLANEOUS(NOT COVERED ELSEWHERE x10.00 = UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = ULINSTED:GAS APPLIANCE>400,000 •BTU x100.00 = USED APPLIANCE<400,000 BTU x 50.00 = ..............................................................................-........................................................... USED APPLIANCE;740O 000 BTU x100.00= AIR HANDLER<10,000 CFM x 12.00 = AIR HANDLER>1 O,000:CFM x 15.00 = SUBTOTAL $ PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT FEE DUE =$ SIGNATURE Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675