1991, 01-03 Permit App: 91000029 Wood StoveJOB. STREET ADDRESS:
MECHANICAL PERMIT APPLICATION FORM
Information tiorksheet
7). 4/703
CITY/STATE/ZIP: � a� , GtI' .. . PARCEL NUMBER:
OWNER:
MAILING ADDRESS: 2 , -p/ g2144--,
CONTRACTOR:
(Street)
MAILING ADDRESS:
PHONE NUMBER:
Zda 9% 'o
(City/State) (Zip)
LICENSE NUMBER:
PHONE NUMBER:
(Street)
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS ITNIT
DUCTWORK SYSTEM
WOODSTOW/INSERT
GAS WATER HEATER
HEATING";EQUIPMENT <100,000,BTU _
HEATINGEQUIPMENT +100,000,.;
GAS PIPING :: (EA -';OUTLET)
REFRIG 1-100M .:BTU(NOT' A/C OR HEAT
REFRIG_101-500M`BTU
REFRIG 501-1,000M'=BTU-------------------------------------------------
REFRIG.1,001-1,75014 BTU
REFRIG +1 750M
HEAT' PUMP _ &- AIR:".CONDITIONER"-0-3"TONS =°=:
HEAT -PUMP'& AIR -CONDITIONER 3 -15 -"TONS
HEAT PUMP. & AIR .CONDITIONER 15-30;.TONS-
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & AIR CONDITIONER +50 TONS
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE' I. HOOD (PER 12' -OR 12' PTN. OF.,.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 <16,000 CFM
AIR HANDLER >10,000 CFM
= 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
3(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 =
x10.00 =
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 =
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