1989, 10-25 Permit App: 89004294 Wood Stove MECHANICAL PER JIT APPLICATION FORM
Information Worksheet� r
JOB STREET ADDRESS: E / t5- L + C_
CITY/STATE/ZIP: LL.14 ?�,2I
+it-Ay-if,'
PARCEL NUMBER:
OWNER: Jr' PLpib PHONE NUMBER: y 2 _/59s--
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR fs . if,f LICENSE NUMBER: el? s /8(0 rn G-
I
VU--/07-7
PHONE NUMBER:
MAILING ADDRESS: /!. 2.2- . wig 9'9207
(Street) City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM x$10.00 = 1
WOODSTOVE/INSERT f x 25. 00 = 2S.Oz
• GAS WATER HEATER x 10.00 =
HEATING EQUIPMENT <100,000 BTU x 12.00 =
HEATING EQUIPMENT +100,000 BTU x 15. 00 =
GAS PIPING (1 - 4 OUTLETS) x 1.00 = }= .
GAS PIING (5 OR MORE. EACH: ) x 1.00 =
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12.00 =
REFRIG 101-500M BTU x 20. 00 =
REFRIG 501-1,000M BTU x 25.00 =
REFRIG 1,001-1,750M BTU x 35.00 =
REFRIG +1,750M BTU x 60.00 = (1!--
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 = 4.)
UNLISTED GAS APPLIANCE >400,000 BTU_ _ _ x100.00 =
USED APPLIANCE <400,000 BTU x 50.00
USED APPLIANCE >400,000 BTU x100.00 =
AIR HANDLER <10,000 CFM x 12.00 =
AIR HANDLER >10,000 CFM x 15. 00 =
SUBTOTAL $ as;en
PLUS: PROCESSING FEE + $ 25. 00
}
EQUALS: TOTAL PERMIT
NOTE: MINIMUM PERMIT F E IS $35.00 FEE DUE = $ ,D.b0
SIGNATURE
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane. WA 99260 (509) 456-3675