1991, 05-16 Permit App: 91002632 Wood Stove MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: S., /020 -J p'loviJ
CITY/STATE/ZIP: .6u,JE, g190204, PARCEL NUMBER:
OWNER: 3bt{Al .513.2f PHONE NUMBER: go/ F‘oeS-
MAILING ADDRESS: 5. /..0 ' / ryrcn/rJ A6,1d .5;'01/../0 .7.62e(
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
WOODSTOVE/INSEI T=;
x 25.00 =
. .... ................ ;::::..........>
GAS WATER HEATER x 10.00 =
GAS 1=QUIPMENT<100 000 BTU{INCLUDES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING (EA OUTLET) x 1.00 =
BOILER/REFRIG 1-100M BTU x 12.00 =
BAIL l3/REFRIG 101-BOOM BTU x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILER/REFRIG 1 x0001-1,750M BTU ` . : x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP &AIR CONDITIONER 0-3 TONS x 12.00 =
HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
HEAT PUMP & AIR CONDITIONER 15-30 TONS x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
HEAT PUMP &AIR CONDITIONER+50 TONS x 60.00 =
VENTILATING FANS x 10.00 =
EVAPORATIVE COOLERS x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
TYPE II HOOD x 10.00 =
CLOTHES DRYER x 10.00 =
RANGE x 10.00 =
GAS LOG x 10.00 =
MISCELLANEOUS (NOT-COVERED ELSEWHERE'' x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTED:GAS APPLIANCE>400,00.0 BTU' x100.00 =
USED APPLIANCE<400,000 BTU x 50.00 =
USED APPLIANCE>400000 BTU x100.00=
AIR HANDLER<10,000 CFM x 12.00 =
AIR HANDLER>10,000 CFM x 15.00 =
SUBTOTAL $
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675