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1992, 10-30 Permit App: 92009545 Pellet Stove
MECHANICAL PERMIT APPLICATION FORM \ r JOB STREET ADDRESS: h ! g7A $ I� y Information Worksheet / -L&. ( CITY/STATE/ZIP: Oi'ee OWNER: MAILING ADDRESS: // ?2/ cf/l a (Street) CONTRACTOR: (A) 4- a4©« PARCEL NUMBER: PHONE NUMBER: 561g1. 232-1 6'/tee49crej (City/State) LICENSE NUMBER: PHONE NUMBER: ?agog'? (Zip) MAILING ADDRESS: (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER :. GAS EQUIPMENT +100,000 BTU DUCTWORK) 4m e BOILER/REFRIG 1-100M BTU 4( BOILER/REFRIG 501-1,000M BTU ESENIKW BOILER/REFRIG +1,750M BTU HEAT PUMP & AIR CONDITIONER 3-15 TONS Lk PRO HEAT PUMP & AIR CONDITIONER 30-50 TONS VENTILATING FANS . ,V, I i � kzW TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) CLOTHES DRYER GAS LOG UNLISTED GAS APPLIANCE <400,000 BTU ::w_!;:�t;�+�,�:�fr��€�y�•,: M'►t#fig.,�J:.•t�,,,,,r�w,3:!^kti!�v�.�.#vvv,�r USED APPLIANCE <400,000 BTU AIR HANDLER <10,000CFM ��'vv?�:.:` t•.:�'••'.•rfQM•�•{r::.}'i:�•QCGr:::;:}Y.t r.�Hv'8.: ;::•. Ally..:.:;•..}...:E�:IE�...,::�!:::�y'<`:•'/:�/:� �r<•:M}:.:«:,?.>'.%''•.'•�'.>:''.•�.'.%r.•�;.•}..}::::••�:}.;:�•::<•::•;:•}:�:.}::•;�::<>.••:<.>::: NOTE: MINIMUM PERMIT F E IS $35.00 i SIGNATURE �✓L, �• 4 V (Zip) NUMBER OF UNITS X EACH UNIT = 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 = x35.00 = x 60.00 = x12.00 = x20.00 = x 25.00 = x35.00 = x 60.00 = x10.00 = x 10.00 = x 50.00 = x 10.00 = x 10.00 = x 10.00 =•- x x 10.00 = x10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = • ' SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675