1990, 11-19 Permit App: 90006261 Wood Stove MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: \O, r,'.
CITY/STATE/ZIP: ;Nr-A:t,,e,k \,‘c-\ C\r"\z-l.ko PARCEL NUMBER:
OWNER: iii1.�,\ Ant PHONE NUMBER:t'\Zc>
MAILING ADDRESS: \ >C \\J \, cto,\c\NSc _
(Street) (City/State) (Zip)
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CONTRACTOR: \\.\ ' A"),Q:. (\ c),,•\) 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 =
X WOODSTOVE/INSERT 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 (EA OUTLET) 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 44A ` x
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 :.V
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 =
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 _ $ (Sc'
SIGNATURE .\�, kt r.\Aia�
Spokane County Department of Building_ and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675