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1991, 11-01 Permit App: 91007494 Pellet Stove
MECHANICAL PERMIT°APPLICATION FORM Information Worksheet JOB STREET ADDRESS: E/.i''o C94✓.4.0"o./ CITY/STATE/ZIP: _93adeoiie, 4/cr4 99.1/4 PARCEL NUMBER: OWNER: Jel,v, S . . Tea w.., PHONE NUMBER: $ aS 92 S. • MAILING ADDRESS: i' /4/90; C5/y40 Co a LJer4, (Street) (City/State) CONTRACTOR: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Zip). (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER GAS EQUIPMENT +100,0$I BTU DUCTWORK) GAS' IPI IG . OUT :> BOILER/REFRIG 1-100M BTU ingtaggiage4MM::><::< BOILER/REFRIG 501-1,000M BTU },�Y[ 1 �ti!.•?:�Y�:ni•F.{:. .�jnv:Yriiii:i BOILER/REFRIG +1,750M BTU �4'.:: x::.}w:: •yy:�I:.w �y��.ryr:::hv: tix::: yr. HEAT PUMP & AIR CONDITIONER 3-15 TONS Eig11121.Th :} !v •N:+'tt'.tir:.fau '1 vvl}r}':.;{...}•:.}::Y.::.w. :..: :.;r.}}:,} -v ''tt •"?y}":i: }iti::v: -vim. HEAT PUMP & AIR C•NDITIONER 30-50 TONS ......: VENTILATING FANS _y::..:}nyfi'.-n}::::n:.ri::s.,,:ev.:.mv.-.•metatt:n' f:. TYPEI HOOD (PER 12' OR 12' PTN. OF HOOD) _ 11 O! y:.: yciEMv:<r:}•:`..'Ori•::::::::t:i::>:-:::'t-::i} CLOTHES DRYER �Sk��m++4 :+ •::itl:::...v. ins%:Si.Yi::4.':v=}i'rvi: i'iic%4::..... GAS LOG :n: TflNS,� F:. f..,. ....,... nom:: t•`';{�: �j\� {] �f�y;�j;�-ay��-: x:1{y:.:���]( .n::�u{mr :ry.� ::-.::.;:.n7v}/:Y fi'.?i:?}:f3%nY{ 1s. 1 : U�F:;:i�{s: (k•' : .. ........................ ............... vJv:.,-.0:: nv:::.:n..v.�:::.:...::::.::�::::::: UNLISTED GAS APPLIANCE <400,000 BTU 0014#0001:0000: OTU f USED APPLIANCE <400,000 BTU AIR HANDLER <10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 x25.00 x 10.00 x12.00 x 15.00 x 1.00 x 12.00 x 20.00 x25.00 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 x10.00 x 10.00 x 10.00 x 50.00 x100.00 x 50.00 x100.00 x 12.00 x 15.00 = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = ,2S; da I SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ SIGNATURE Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675