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1990, 09-13 Permit App: 90004578 Pellet Stove
u MECHANICAL PERMIT APP KATION FORM c,v 1 y V) Information Worksheet ( tw JOB STREET ADDRESS: �i//// F///OL�y,,/ /o / V 5zl 6S l CITY/STATE/ZIP:iJ,4S6• 7��(.UPARCEL NUMBER: OWNER: .19,og L�l L PHONE NUMBER: MAILING ADDRESS: /I/OS (Street) (City/State).. .(ZIP),. CONTRACTOR: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Street) (City/State):. _. MECHANICAL WORESHEEt/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT DUCTWORK SYSTEM_ _ _ _ _ _ _ .x$10.00 = WOODSTOVE/INSERT GAS WATER HEATER _ _ _ _ -- `__.- _ _ HEATING EQUIPMENT <100,000 ETU _ _ _'_'_ HEATING EQUIPMENT +100,000 BTU _ _ _- GAS PIPING+(EA OUTLET) - •''. REFRIG 1-100M. BTU (NOT A/C OR HEAT PUMP) REFRIG 1,001-1, 750M. BTU,,- REFRIG +1,750M BTU _•_"_} 'HEAT,PUMP,&''.AIR; CONDITIONER 0-3TONS; _gw^"�, HEATPUMP?,&'AIRCCONDITIONER-3 15'TONS�, HEAT 'PUMP :&. AIR,`CONDITIONER-15-30 :TONS HEAT PUMP '&^AIW CONDITIONER 30-50 TONS -.,l HEAT PUMP&.: AIR.CONDITIONER.+SO.TONS _ _ VENTILATING FANS _ _ _ ' EVAPORATIVECOOLERS_ _ _ -TYPE I HOOD (PER 12' OR 12' PTH. -0F HOOD) TYPE II HOOD - _ _ _ _ _ _ _ -_z. CLOTHES DRYER_ _ _ _ _ _ _ _ _ _ _ _ _F_' RANGE_ _ _ _ _ _ _._ _ _ _ _ -;-:. GAS IG _ MISCELLANEOUS (NOT COVERED ELSEWHERE)_ _. UNLISTED GAS APPLIANCE <400,000 BTU_ UNLISTED GAS APPLIANCE >400,000 ETU_ USED APPLIANCE <400,000 BTU_ _ _ _ _ _ _ USED APPLIANCE >400,000 BTU_ _ _ _ _ _ _ AIR HANDLER <10,000 CFM _ _ _ _ _ _ _ _ AIR HANDLER >10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE x 25.00 = x'10.00 = x'12.00= x`15.00'= 777-7-7 -' x 1.00 x.12.00 = � X, 20.00'. .. x35.00 x 60.00 X 10.00 = x 10.00,:= x50.00 x:10.00: x'10.100'= x:10.00`= x'10.00'= x 10.00 = x 50.00 = X100.00 - x 50.00 = X100.00 x 12.00 = x 15.00 = SUBTOTAL $ PLUS: PROCESSING FEE +�$ 25.00 EQUALS: TOTAL PERMIT FEE DUE _ $ Spokane County Department of Building and Safe West 1303 Broadwav Avenue Spokane, WA AND (5 9) 456-3675