1993, 04-22 Permit App: 93002773 Water HeaterMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
PARCEL NUMBER:
JOB STREET ADDRESS: Al .30 c) 4
CITY/STATE/ZIP: S k.iti A -
OWNER: -)it1( Aitj
MAILING ADDRESS:
CONTRACTOR: 0. IL
(Street)
'Z.55.107.. 0.7
PHONE NUMBER: d/1/1
/PO
(City/State) (Zip)
LICENSE NUMBER: 0 4 Pic) II C.) L. Ls
PHONE NUMBER: D.641).3)
MAILING ADDRESS: d- N ..rt;
(Street (City/State)
DESCRIPTION
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
ASIONIVORK
GAS WATER HEATER
16.1656
GAS EQUIPMENT +100,000 BTU DUCTWORK)
NADWIFLIT:r•W•v•Y•x•w•:, v.•:•47:•:•
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
NORTIKartab titek
BOILER/REFRIG +1,750M BTU
"MIKM:.,)1,411.1MEMOTAW14.7'
HEAT PUMP & AIR CONDITIONER 3-15 TONS
IIIII
&Or
•:•
x 4
4.4W
Kftwiltismi„,riaraican 49M1§24e,
HEAT PUMP & AIR CONDITIONER 30-50 TONS
7411:401*ArgaffelMEMT:41101E
VENTILATING FANS
P•1.4.
-""IfOraitiain
TYPE 1 HOOD (PER 12' OR 12' PTN. OF HOOD)
XV•4 V>, 5%.
CLOTHES DRYER
iilASOKL7'.: *:
GAS LOG
•
ye" :•::.A#••
UNLISTED GAS APPLIANCE <400,000 BTU
':KirereqcieritityVime:iigja
USED APPLIANCE <400,000 BTU
t3„, • ,
, • ::„:„...„:„„„..,„„„„„„„,:„::„„,„:*::„„:::,::::,,:,,„::::„„„
AIR HANDLER <10,000 CFM
•
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x10.00 =
x25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x1.00 =
x 12.00 =
x20.00 =
x25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x10.00 =
x10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x10.00 =
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