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1989, 10-04 Permit App: 89003820 Wood Stove MECHANICAL PER 'T APPLICATION FORM Information Worksheet JOB STREET ADDRESS: (L( a1_ CITY/STATE/ZIP: (../e' 4 D/106141e. ,-9.03'7 PARCEL NUMBER: �" 1 % U�/ OWNER: CF/92(Cs-,;(Z.av/e/ 7 ?0 PHONE NUMBER: 92a hoz ' MAILING ADDRESS: 55,47 (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 = 2.5 GAS WATER HEATER x 10.00 = HEATING EQUIPMENT <100,000 BTU x 12. 00 = HEATING EQUIPMENT +100,000 BTU x 15.00 = GAS PIPING (1 - 4 OUTLETS) x 4 . 00 = GAS PIING (5 OR MORE. EACH: ) 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 $ 25 PLUS: PROCESSING FEE + $ 25. 00 EQUALS: TOTAL PERMIT NOTE: MINIMU PERMI FES $ 5.00 FEE DUE = $ SO SIGNATURE _ �. Spokane County Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675