1992, 11-18 Permit App: 92010200 Water Heater, FurnaceMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: / / y 6 / Cc 7/47iQ +' �j
CITY/STATE/ZIP: . cfrk.',^�e //�� PARCEL NUMBER:451P-,O)QZ
OWNER:PD¢ic-7 �% PHONE NUMBER: �o� l% {%1 s'
MAILING ADDRESS: 1,4"--1/D3 //t G /'�%
7 // (Street) (City/State)
CONTRACTOR: Jc3 44 es flea Re -7
MAILING ADDRESS: A/ 2 a02 S
(Street)
DESCRIPTION
�/
/ (Zip)
LICENSE NUMBER: ON E 5 Ij 2/%'9 /VA/
PHONE NUMBER: Vit `Fir
Y /
4,/ 5/9.e te6„ e, 92&2
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WQODSTQVE/(NSgtt
GAS WATER HEATER
G`AS EQUIPMENT, 4100,008 RTt1(INCtOb.
GAS EQUIPMENT +100,000 BTU DUCTWORK)
, i 'Ns (4 Uj,E1,).v
BOILER/REFRIG 1-100M BTU
1B;QILEP/AEFIRIG1t 1-SWM,BTh
BOILER/REFRIG 501-1,000M BTU
140ILER/REFR1G„1,,0001 ,750M..9
BOILER/REFRIG +1,750M BTU
:IE::.AT PUMP &AIR CONDITIONER d 3 TQNS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
4111pYMP&AIOCONDITi9Nai5„ 0TAS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
;F{EAT PUMP & AIOONDIT OR t)m7C
VENTILATING FANS
,tvXPoRKSICO9OLE
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPEI t_ HOOq,:.::1
CLOTHES DRYER
GAS LOG
MISCEL;LANEOUS.(NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE 5400,0008.":
..........:.:............................................................::..............
USED APPLIANCE <400,000 BTU
..........................................................................................
USED APPLIANCE.>i00,000:5TU ...
AIR HANDLER <10,000 CFM
AIIR HANDLER>10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATUF
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x60.00 =
x 12.00 =
x20.00 =
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 =
/
/Q, Do
/
/a, 62'2
SUBTOTAL
$ d a w
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ i\
/4
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675