1993, 04-19 Permit App: 93002669 Water HeaterMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: S LLLi L{ Z, C- 1 LA_ I s CZ 0 ,
CITY/STATE/ZIP: PL �'� \f. ( of 2- C (e, PARCEL NUMBER: /%O% O o%
OWNER: (V\ C. I" (& L S t pA C PHONE NUMBER: Cf 2 2 2.--) '7e.)
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: I..', l 0 1' LICENSE NUMBER: l,. I W LSA t dl 0 6k
PHONE NUMBER: .) Lir'
MAILING ADDRESS: N t 7 to 1 (e 0.1 r (`Z n S P C' K Lf' '4
(Street) . (City/State)
026 °y
AffL „l 4-Z4- XMECHANICAL WOR
DESCRIPTION - -
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
•
•
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
kistiettifiNaiNIU
BOILER/REFRIG 1-100M BTU
agoftgeMEIKOM
BOILER/REFRIG 501-1,000M BTU
':,'•5 . 1#E two, ''^T.•r• eW6 g • '. :a. J 't. " ":. `,' •"wo- ,.$%` :
BOILER/REFRIG +1 ,750M BTU
yv::::.v::v,y::..ffielg :�"'':.iir' f y..:. •: 1.
HEAT PUMP & AIR CONDITIONER 3-15 TONS
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•`dry :;
HEAT PUMP & AIR CONDITIONER 30-50 TONS
1„b x1P•: ;„,,0:01.. .,
VENTILATING FANS
iM
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
ywyr:yr:ayv{::.y. f.; f �:; t•..
".'•, i,r..
,44
CLOTHES DRYER
:fot : i •.,�W 'k X` u... :• ,;' . ., :'3?fi 35 .:rte`.: ; '„ter{.:+
GAS LOG
UNLISTED GAS APPLIANCE <400,000 BTU
:
EITON
USED APPLIANCE <400,000 BTU
}:n•{. xf •y .::,,;y�:y,�,y,:y�:,v:•x•71oN yn•ta;;: {.:: :y;{ ` :•`.:•'<6:•:tr
AIR HANDLER <10,000 CFM
•
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x10.00=
x 25.00 =
x 10.00 =
x12.00 =
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 =
x25.00 =
x35.00 =
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 =
x15.00 =
-
/
{
J,
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_ $
Spokane County Division of Buildings