1990, 09-06 Permit App: 90004418 WoodstoveJOB STREET ADDRESS:
CITY/STATE/ZIP:
OWNER:
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
/o� /I/. �Co �A �l�
6�ptiie(�eS�14 PARCEL NUMBER:
9�0/v ftrEre
�'ON /U. �= PHONE
4t1 f� ( NUMBER:
MAILING ADDRESS: �4 kr)
(Street) (City/State)
CONTRACTOR: ,V A
MAILING ADDRESS:
(City/State.
7`7
(Zip)
WORKSHEET/FEE SCHEDULE
NUMBER `; X EACH
OF UNITS ITNIT : =
DUCTWORK SYSTEM_
WOODSTOVE/INSERT
GAS WATER, HEATER
HEATING EQUIPMENT -<Y0-6:600 BTU
HEATING:; EQUIPMENT +100,000. BTU
GAS PIPING . '(EA .OUTLET) s _
REFRIG ;,1-,100M { BTU ,`` (NOT .A/C' OR HEAT PUMP.
REFRIG;101500,BTU ?r<_:
REFRIG501-1):0,0OM, BTU
REFRIG 1,001,1, 7,50MTU_' t j
REFRIG +1, Y50MBTU�'?E
HEAT PUMP 4' AIR ONDI�IONER-:0=3 TO gy7V."
HEAT '`'PUMP&'ATR" CONDITIONTER3-15;TONS
HEAT `PUMP , & . AIR. CONDITIONER 15 30"; TONS
HEAT PUMP": & .,'AIR�-CONDITIONERAa30 50; -TONS
HEAT :PUMP,. &HAIR; CONDITIONER +50.,.:TONS
VENTILATING FANS,
_.
EVAPORATIVE,' COOLERS_
TYPE 1 HOOD> (PER 12' OR 12' PTN. Or HOOD),
TYPE II HOOD , _
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED' ELSEWHERE)
UNLISTED GAS APPLIANCE <400,000 BTU
UNLISTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM.
AIR HANDLER >10,000 CFM
x$10:00:=
x',2500=
x10.00
00
x
X 3 UU:.
x,12:0
x y20. 00.
xvy
AMOUNT
x
x.,35:
x +60.0
x '10.00
x 10.0017=
x 50.004
X.10 .00 T-
x ;y; 10.00` f
x'10:00'
x 10.00 =
x 10.00 =
x 50.00
x100.00.:r=
x 50.00
x100.00
x12.00 =
x 15.00 =
c.
z
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
$ ZS.o6
PLUS: PROCESSING FEE
+'$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 56,0
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (5U9) 456-3675