1991, 10-10 Permit App 91006748 Pellet Stove MECHANICAL PERMIT APPLICATION FORM /
' Information Worksheet ,/
JOB STREET ADDRESS: 6/0 . N G LJe r ree r? ! /
CITY/STATE/ZIP: 5'7U 11-caVI e ct) 992 (� PARCEL NUMBER: l `� S.'Z
OWNER: LainQ..e. v t' PHONE NUMBER: ? / -`773 �T
MAILING ADDRESS: CG 10 tf re.eV'1
(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 1=QUIPMENT<100;000 f TU(INCLUDES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
............................................................................................................................................
............................................................................................................................................
x 1.00 =
BOILER/REFRIG 1-100M BTU x 12.00 =
x 20.00 =
...........................................................................................................................................
......... ................................................................................................................................
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILER/REFRIC 1,0001 1,750M BTU x 35.00 =
BOILER/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 =
NET PUMP AIR It ITIONER 15-30 TANS 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 =
EVA• PORATIVE COOLERS x 10.00 =
•
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
TYP II HOOD x 10.00 =
CLOTHES DRYER x 10.00 =
x 10.00 =
GAS LOG x 10.00 =
MISCELLANEOUS;(NOT COVERED ELSEWHERE: x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTED AI APPLCANCE>400,000 BTU '"`:::>>: :: x100.00 =
USED APPLIANCE<400,000 BTU x 50.00 =
USED, PP ,IANcE>400,400 BTU x100.00 =
AIR HANDLER<10,000 CFM x 12.00 =
AIi HANDLER 1t),O00 CF=M x 15.00 =
SUBTOTAL $
PLUS: PROCESSING FEE + $ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE _ $
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675