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1990, 07-12 Permit App: 90003284 Wood Stove MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: oI" ,V/c;,2_, /07(i .4 CITY/STATE/ZIP: 0 .7..)(, C24 9901/L.-- PARCEL NUMBER: OWNER: ,Qz_f 0A2' f,) PHONE NUMBER:6-9) 5 s y-3 t;& MAILING ADDRESS: 69/.,Z. /6 7;4 ,1/c ( -. . % %f- 0` �► (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 1710014,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,;001-17.50M BTU - - x 35.00 REFRIG +1,750M BTUs` _ x 60.00 = HEAT. PUMP',"&`,`:AIR'.CONDITIONER 0-3 TONS _ x 12.O C = 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 (5U9) 456-3675