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1992, 12-21 Permit App: 92011081 Wood Stove ' MECHANICAL�ERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: ��-`� 111 CITY/STATE/ZIP: ����� , ` 9 ° 7 PARCEL NUMBER: OWNER: Ke v P,(.._, ���a� �� / PHONE NUMBER: `� �` `/ y MAILING ADDRESS: PL �`I-5; V���� u' �` �� `T `l�' (Stree (City/State) (Zip) CONTRACTOR: c�i u= �Ev� 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 = V�Ip Q�ST�V�L...�.:::.;::�.;:.: .......::,:.:::<.;;::.;:::<... x 25.00 = GAS WATER HEATER x 10.00 = :.: .::::; .:; .:.;:.; ;:: :.:::>::>:;.;11;11: ;.;:.>..; .: :<;::.;.: (INCLUDES'>'< »>< ' :.- x 12.00 = GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = ;1111:;.-. ; �� �>- �>�' > <�> >< <��<� ><>�<.1111.1111><<`<'€< x 1.00 = BOILER/REFRIG 1-100M BTU x 12.00 = 2 0 = :.>�.>-'�I'<8>�>:� ><><�><<»�><«`>`>< ><� < >'»;11;11>< x 00 BOILER/REFRIG 501-1,000M BTU x25.00 = :::<. >:-1V1�� -��<<> ><> '<� >1111>><><« >»<> x3 .E0114.0143- 5.00 = :Etz.-"0.. 4::.;:..;:14"-::p-R- :.;, .;: ;x.,:;.::::L�F1�1=t<I�I:ia'�<i�Qd�> Q.::::::.�:'-'.1:::: :;:.;:.; .;;; ;:::.;:.; ;;> :::::. BOILER/REFRIG +1,750MTU x 60.00 = 2 = H���"#:'1�M1� }:�tEt> .�1.!,:t.:;0....-IV,::::.�:�:.::�:-::::Q':::: :.;:.; ;.. ..;: x 1 .00 HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 = 2 .00 = 1 ,11:;111:�. :.;....:�;:.;;:;..;.:: ;�; :.::.:,:::.::.; ::::.;.::.: :::.::.:::::.: x 5 NA'i`<PMP.> <At1fl 'I? w1 v : :.;;;;;;;. .:.;:.;.:.:.: HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 = ;111;1:�::::::.>.::.:.:�;.:: :.::.>:.:; ::::.::..;:: ::: :::... >._�.>�..N: '` >«. .1111;:.1111>> > x 60 .00 = F�"i`:: llME:''��At�t�GC11�t�i'E'II���.;;::5�.::::0.:::5 ;;. VENTILATING FANS x 10.00 = <<><r><>`><» >><» > ` < ` .. ...... < > x10.00 = �1lE�C7�#�l`C`all' � C?t7L�...S.. :::.::::::::::.:::............:..:::::::::::::. .............................................. TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD) x 50.00 = :<:.:>:;<:<;::::»11;11 ::.>:<:::>::>::»»:: x 10.00 = ���'� � ��....... ........ ;1111::>:::;::::::::.... ............. 1111. CLOTHES DRYER x 10.00 = ><<`<``><>;' »'<< <'< > < <> .......,,,*::2:-.--.--:-.- .....,...........,....:,....,,,1 ` x 10.00 = C# � ::::........... GAS LOG x 10.00 = 1=<<`:' .1111:. x 10.00 = Al.;'`r='LA►N NCS CC ti`C `` LS u11F „ 1111;;;$ :;;;.;:;:.;.;C-.US:.: .;;:;;: : :::::.: ::: :: :::T1.-:::::........................... UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = :.......�-... .:. ....::;. :.;,::.:: <'' >``. IIIb .....1. x100.00= LINS•'El�GAShPt�ANQ��,44��ti�U...'�:.::.;;:.; . ;.> USED APPLIANCE<400,000 BTU x 50.00 = :.:::::;::.: .;:.;:.;::::::..: ::::::.;::.;:.;:<.;:;:.;-11;11; x100.00= •ii AIR HANDLER.10,000 CFM x 12.00 = tut .€><'>«><>< «< •> .1111>< >> 1111. x 15.00 = Ala HANbLEl 1t ,+DaO.C.::.;.;::.;::.. SUBTOTAL $ PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT FEE DUE _$ J�Q-cam SIGNATURE Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675