1992, 09-03 Permit App: 92007183 Pellet Stove Spokane County
DEPARTMENT OF BUILDING & SAFETY
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
INFORMATION WORKSHEET
PARCEL NUMBER:
STREET ADDRESS: 6 3 k 2 U 44-
CITY/STATE/ZIP: ),t1-- e) /L-(
SUBDIVISION:
BLOCK: LOT: ZONE: DISTRICT:
LOT AREA: F/A: WIDTH: DEPTH: R/W:
# OF BUILDIINGS: # OF DWELLINGS: WATER DISTRICT:
OWNER: Le.co ,- PHONE: SO, - 5SS -
MAILING ADDRESS:
CITY/STATE/ZIP:
CONTACT: PHONE: - -
SETBACKS: - FRONT: LEFT: RIGHT: REAR:
PERMIT USE:
****************************************************************************
BUILDING INFORMATION
CONTRACTOR LICENSE NUMBER:
CONTRACTOR: PHONE: - -
MAILING ADDRESS:
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS:
NEW: REMODEL: ADDITION: CHANGE OF USE:
DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES:
BUILDING DIMENSIONS: X (WIDTH X DEPTH) SQ. FT. :
REQUIRED PARKING: # HANDICAP: SPRINKLERED: CRITICAL MATERIAL:
Please provide the following information for Energy Code compliance:
Space heating type (check one)
Forced air electric Electric baseboard or wall mount Propane
Forced air gas Heat pump Other:
Flat ceilings R Doors U
Vaulted ceilings R Windows U
Above grade walls R Glazing area %:
Below grade walls R Total floor area
Floor R of heated space
Slab on grade R Furnace efficiency rating
Please indicate on your plans: The location of the radon vent, and the location of the vent fan area.
Square footage
Main floor:
Second floor:
Basement - Finished:
Unfinished:
Garage:
Carport:
Decks:
Additional Areas:
MECHANICAL PERMIT APPLICATION FORM
Irrformation Worksheet
cs
JOB STREET ADDRESS: • 6 33,\ i U+�
CITY/STATE/ZIP: -5-10 tAJ PARCEL NUMBER: a -1533 --Uyh'-
OWNER: Er"- 4L - - Leo-, PHONE NUMBER: 535- 33-2`9
MAILING ADDRESS: -SwV".e 4s ,4-looms
(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
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
x 25.00 =
GAS WATER HEATER x 10.00 =
GAS EQUIPMENT<100, 00 BTU(INCLUI ES' ::::': x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
x 1.00 =
BOILER/REFRIG 1-100M BTU x 12.00 =
s3
x20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILEI /Rf=ERIQ 1,0001 1,750M BTU' %. x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEA 1`PUMP&AIR CONDITIONER 0 $TONS......... x 12.00 =
HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 =
.00 =
SAT PUMP&AIR+�t`�NL?ITI�1N 0:04$4111:0N.S `::;>;::: ' x 25.00
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
HEAP'PUMP AIR ONDITI NER+50 TANS x 60.00 =
VENTILATING FANS x 10.00 =
x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
x 10.00 =
CLOTHES DRYER x 10.00 =
x 10.00 =
GAS LOG
x10.00 =
MISCELLANEOUS(NOT COVERED ELSEWHERI=:<::> ::` ' x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTI=D GAS AI PLIANCE>400 a 00 U ;.`: x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
USED API LIANCE pt,000 BTI ;:;: . ' x100.00=
AIR HANDLER<10,000 CFM x 12.00 =
x 15.00 =
SUBTOTAL $
PLUS: PROCESSING FEE +$ 25.00 .
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$
SIGNATURE -/-:120,11
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675