1990, 11-05 Permit App: 90005918 Wood Stove 1
MECHANICAL,fit ERI'IT APPLICATION FORM q
Information Worksheet I VI/t s�
JOB STREET ADDRESS: J3//9 1
CITY/STATE/ZIP: (7/0/40L4jArif PARCEL NUMBER: l 1 -1 3a-
OWNER: %/;itiD4 ?/Zs7 74--e."/ 722.- ye_ PHONE NUMBER: 7--- -1--/.99/
MAILING ADDRESS: :-r 2- `J9.2 /eel 7,file '`' 1f 27
(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 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' 1O1-500M: BTU x 20.00 =
REFRIG 501..-1000M 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 =
HEATPUMP & AIR CONDITIONER 15-30 TONS x 25.00 =
HEAT PUMP' & AIRCONDITIONER;� �,-
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. s--` 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 99260 (509) 456-3675