1990, 04-04 Permit App: 90001269 Pellet StoveJOB STREET ADDRESS:
MECHANICAL I0ERMIT APPLICATION FORM
Information Worksheet
(C-7-3?/ 7 /27A92
CITY/STATE/ZIP:5:kqN¢, /JaJ 72/4 PARCEL NUMBER:
OWNER: , licv# (<11-c-)1,7 fO/.S c PHONE NUMBER: 72! - 29/4
MAILING ADDRESS: f/39/ 7 2/ /4 S,oc,kfq .)e WA) 992 Ur
(Street) (City/State) (Zip)
CONTRACTOR: ,SAvoe a3 /980212 LICENSE NUMBER:
PHONE NUMBER:9,2b -. 9/ ,
MAILING ADDRESS: 5A/Y)-e_ LIS ,4/501./e.
(Street)
(City/State)
(Zip)
MECHANICAL
DESCRIPTION
WORKSHEET/FEE SCHEDULE
NUMBER
OF UNITS
X EACH
UNIT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (EA OUTLET)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II H000
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
J
= AMOUNT
x$10.00
x 25.00
x 10.00
x 12.00
x 15.00
x 1.00
x 12.00
x 20.00
x 25.00
x 35.00
x 60.00
x 12.00
x 20.00
x 25.00
x 35.00
x 60.00
x 10.00
x 10.00
x 50.00
x 10.00
x 10.00
x 10.00
x 10.00
x 10.00
x 50.00
x100.00
x 50.00
x100.00
x 12.00
x 15.00
2 -;
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675