1991, 08-29 Permit App 91005427 Pellet StoveMECHANICAL PERMIT APPLICATION FORM 74 ,a
Information Wo►ksheet vim_. a,_
JOB STREET ADDRESS: I -] C) C) 171), 4..7C0-\(
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CITY/STATE/ZIP: V.e-c- C//4)�--e I � OLclO�� PARCEL NUMBER: 1 -� `T`r ��� L
OWNER: e -looC61 v r -Q \- tY\ PHONE NUMBER: ` aa:-1'-195S/
MAILING ADDRESS: Q
CONTRACTOR: C')U.)
MAILING ADDRESS:
(Street)
(City/State)
LICENSE NUMBER:
PHONE NUMBER:
(Zip)
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER
GAS;EQUIPMENT <100,000 BTU (INCLUDES
....:.....
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS. PIPING (EA OUTLET)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 1010M RTU >
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,0001 y,750M>01
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITjONBIl 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 15.-30 TONS;
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT.PUMP;& AIRCONDITIONER +50 TONS
VENTILATING FANS
EVAPORATIV
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GASLOG,:::........_...................................._.......:.....................................
MISCELLANEOUS(NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE<400,000 BTU
USED APPLIANCE >400000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM; 00
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x10.00 =
x 10.00 =
x1 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 Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675