1990, 11-15 Permit App: 90006167 Wood Stove MECHANICAL PERMIT APPLICATION FORM
Information. Worksheet
JOB STREET ADDRESS: Zp yp`)a C• y Ty Ade-. a2 y s 3 P - 2o l 9'
CITY/STATE/ZIP: 5PK )A1E Li/A q9G J< PARCEL NUMBER:
OWNER: U0/9A/A1E . Imo/L1.-/AmS PHONE NUMBER: 6-13e1--505-5
MAILING ADDRESS: „5/-2/7lE As Ab6n.JE
(Street) (City/State) (Zip)
CONTRACTOR: SE"LJ= 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 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 =
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 =
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
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675