1990, 10-09 Permit App: 90005254 Pellet StoveMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS • in (a_ A
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: C"U
MAILING ADDRESS: / j fid ('r
(Street). (City/State) (Zip)
spa LUCAS 7
CONTRACTOR:.
MAILING ADDRESS:
(Street).
City/State) (Zip)
DUCTWORK SYSTEM
WOODSTOVE/INSERT
,GAS WATER ;;HEATER;
T�f PU
T„ P JMPr`
►T;°PUMP ;°&4 AIR_
Y VENTILATING, ;FANS; —
:EVAPORATIVECOOLERS:'
TYPE I HOOD `,(PER ":12°'
TYPE' II HOOD _
CLOTHES DRYER
GAS_
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 1V".uV =
x 10.00, °=
x 10:q0,=
x'.10.00
x 10.00
x 50.00 =
x100.00 =
x 50.00
x100.00 -`_
x 12.00_=
x 15.00 =
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
PLUS: PROCESSING FEE
EQUALS: TOTAL PERMIT
FEE DUE
+ $ 25.00
= $
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675