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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