1991, 10-07 Permit App: 91006597 Pellet Stove r
✓' t
MECHANICAL PERMIT APPLICATION FORM
Inloration Worksheet
JOB STREET ADDRESS: G 90‘ .
/ O‘ ' `O%vy )f 0 ' "
CITY/STATE/ZIP: Gz PARCEL NUMBER:
OWNER: J}1191" Y $f`Y 'ff L'__ PHONE NUMBER:
MAILING ADDRESS: P‘r0 to GO 4074,44c-c- �� 771/
(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 EQUIPME T<100',000 `U (INCLU ES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
x 1.00 =
BOILER/REFRIG 1-100M BTU x 12.00 =
ILEI /REFRIG 101-500M BTU x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILER/REFRIC 1x0001 1,750M BTlJ ;" : :: :. x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP i&AIR C NDITIONER TANS ;;: x 12.00 =
HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
NSA'rPomftltm:.:i.:::: 1..:::::::::::v4f1!.:::{?ti5.::::::::.:::.:.:.;:.::;<.:
x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
HEA T PUMP :'1It Atli CONDITIONEf +50 TONS 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 =
x10.00 =
GAS LOG x 10.00 =
MISCELLANEOUS(NOT COVERED ELSEWHEIRE:::igi.;;:`; x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
x100.00=
AIR HANDLER<10,000 CFM x 12.00 =
x 15.00 =
SUBTOTAL $
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
/ FEE DUE =$
SIGNATU�� ..,
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675