1989, 10-13 Permit App: 89004027 Wood Stove MECHANICAL PERMIT APPLIATION FORM
Information Worksheet
JOB STREET ADDRESS:_j,a goo? C t A)/A)I 4Q/'J
CITY/STATE/ZIP:Vr")/afe_ Gc) Q;2/6 ' PARCEL NUMBER:
OWNER: (l2 o/Ili s 1,74o0/4 G61)/ PHONE NUMBER:_ 2 4/LE-2-5
MAILING ADDRESS: I A q a2 c cog/ter) 4V�
(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
DUCTWORK SYSTEM x$10.00 =
WOODSTOVE/INSERT O x 25.00
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 =
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 BTUx 50.00 =
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 $
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT^
NOTE: MINIMUM PERMIT FEE IS $35.00 FEE DUE = $
SIGNATURE
Spokane County Department of Building and Safety ACC 0C7C