1990, 06-18 Permit App: 90002782 Water HeaterMECHANICAL PERMIT APPLICATION FORM
aa Infarmaticnn Worksheet
JOB STREET ADDRESS: A , /1 (4 Fa. w r -N
9e) - 7 (f)�
CITY/STATE/ZIP: S p c 1%v\ e ,way. 5/4°C :PARCEL NUMBER:
OWNER: re. d f= our n ; -e c PHONE NUMBER: C) 2 L71 - 6- 3 2
MAILING ADDRESS: 5. / 7 / / f a w
(Street)
CONTRACTOR: A I r k c►, -e r v
Spek t e,cuc.. gg2oG
(City/StaAte) (Zip)
c e S LICENSE NUMBER: 4 L P f4
CoONE NUMBER: LI (, 7- 6 G g'L7L
MAILING ADDRESS: f• e c X. 5 6 5 .$eikoLv. e C,,�a
/(City/State)
(Street)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
DESCRIPTION
9'9 2.c
(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 I -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 & AIR CONDITIONER 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 & AIR CONDITIONER +50 TONS _
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II 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 <10,000 CFM
AIR HANDLER >10,000 CFM
f
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 =
/6,o0
NOTE: 77ZIM PERMIT SEE IS $35.00
SIGNATURE
171
Spokaf�e County Department of Building and Safety
West 1303 Broadway Avenue Spokane, 'SVA 99260 (509) 456-3675
SUBTOTAL
$ /o. ob
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $35,0-6