1992, 12-22 Permit App: 92011119 Water HeaterMECHANICAL PERMIT APPLICATION FORM
-1 7
Workse
JOB STREET ADDRESS: /\) .41 1/6ti r6,1
CITY/STATE/ZIP: 57l:/0
OWNER: :1 tt //1( Cita C7;40
PARCEL NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
I(Street)'
(City/State) (Zip)
CONTRACTOR: 741/yL 2-icq LICENSE NUMBER: 3, -/*-S1 7
PHONE NUMBER: c- P/1 51-14V---7)13110-
MAILING ADDRESS: /27/73 /Ai
•tex)
(Street)
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
- NUMBER X EACH
OF UNITS UNIT
DESCRIPTION
(Zip)
= AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PIING (5 OR MORE. EACH:)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
EVAPORATIVE
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS
3-15 TONS
15,,30 TONS
30-50 TONS
+50 TONS
COOLERS
TYPE I HOOD (PER 12' OR 12'
TYPE II HOOD
PTN. OF HOOD)
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)
UNLISTED GAS APPLIANCE <400,000 BTU_
UNLISTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER .11:1,,,opopfsm
AIR: HANDLER >I940WcFM
NOTE: MIKE= PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 4.00 =
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 =
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 =
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 35reo
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-367"err?)