1991, 10-15 Permit App 91006857 Pellet StoveMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET
'S1uj'. v�
Uwnttt:
X EACH
UNIT
PHONE NUMBER:
MAILING ADDRESS 52/w
P .
(Street)
(City/State)
(Z',;) -
CONTRACTOR: rgICJ1
y14fLYGnl CizijfF9.
LICENSENUMBER:_ri4)CD&e_1-73DLk
a;:s
PHONE NUMBER: SO6i)
q.2b-8911
MAILING ADDRESS: E•
q3)Q _SxQ0A%&e
S KAiJ2_ LI-) ti
0192Dt'o
(Street)
(City/State)
(Tp)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (S ABATE SYSTEMS)
T'OV;EjI SwVq�"°�. i��� ';�.• ,:
GAS WATER HEATER
�GAS�„_„�; �.Q�L�L��i..,'�,.�c1Q0,0100�� N.•�ES
GAS EQUIPMENT+100,000 BTU DUCTWORK)
G 4GU11
BOILER/REFRIG 1-100M BTU «
BOILER/REFRIG 501-1,000M BTU:
750M
HEAT PUMP & AIR CONDITIONER 3
HEAT PUMP & AIR CONDITIONER 31
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)--
CLOTHES
OOD) _CLOTHES DRYER
GAS LOG
M�scr11'or' .o ..............>
UNLISTED GAS APPLIANCE <400,000 BTU -
ULIIg��.w,
USED APPLIANCE <400,000 BTU
AIR HANDLER <10,000 CFM
%11R ANDLER �y tl,000 GFM e vex .. TMM
NOTE MINIMUM PERMIT FEE IS $35.00
SIGNATU
NUMBER
OF UNITS
X EACH
UNIT
=AMOUNT
X10.00 =
x 25.00 =
x 10.00 =
X12.00 == .
x15.00'=' .
x,1 00
X12-00 =,
x 20.06.'_—
x 35.00
X 60.00
x1200 _
x2000 '
x 25.00
x 35.00
x 60.00
X10.00 =
x10.00 =:
X 50.00 =
x 10.00
x 10.00 =
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 =
a;:s
SUBTOTAL
$�
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_$ 0 -coo
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-31375
L
61