1992, 07-09 Permit App: 92005117 Pellet Stove MECHANICAL PERNHT APPLICATION FORM
Information Workshe
JOB STREET ADDRESS: 5. °7v CJ�ria-rl e- Vs.-
CITY/STATE/ZIP: V Ccota' j,,,,�, A 03 PARCEL NUMBER: 1�.� �� ®3d7
OWNER: ifi► (i► G-M �l f� ,(AASO/1 7 PHONE NUMBER:
MAILING ADDRESS: Gam_
(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 =
x 25.00 =
GAS WATER HEATER x 10.00 =
GAS EQUIPMENT<100;00.401:1.... (INCLUD S x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
x 1.00 =
BOILER/REFRIG 1-100M BTU x 12.00 =
BOILER/ EFRIG 101-5 i M TU ..... :> :>':;`>'::>.:..;>::::.>;::::>.:: x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILER/REI=FIIC x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEA'C PUMP&AIE C DITIC NE1 0 3 TANS x 12.00 =
HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
HEAT U P AIR CONDITIt NER 15-3 TONS x 25.00 =
•
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
HEAT PUMP AIR ONDITI )NE t+50 TONS x 60.00 =
VENTILATING FANS x 10.00 =
x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
x1000 =
TYPE I H
.:.: ...:.:.:.:..
CLOTHES DRYER x 10.00 =
.: x 10.00 =
GAS LOG x 10.00 =
MISCELLANEE US(NST COVERED I=LSEWHER x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTEC SAS APPLIANCE>400,00 BTU:::; : x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
USEa pPLIANCE 400x000 BTU `>::: x100.00=
AIR HANDLER<10,000 CFM x 12.00 =
AIRHANILEI X10,000 CFS 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