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1990, 12-24 Permit App: 90006918 Water HeaterJOB MECHANICAL PERMIT APPLICATION FORM Information Worksheet I /4 S'/ STREET ADDRESS: /75 -is \ -,ept /!.(l_) /7,0__A744p. GeCt PARCEL NUMBER • //4.0,4 5,,,,, l &yr.-ri in PHONE NUMBER:(oo• 8007 ADDRESS: //T/S v-AppeMit"4-- (Street) (7eaG/PlnOu),4)-- Q%.O G, / City/State) (Zip) CONTRACTOR:Y//tab1/C/y 01/71/;19 NUMBER: $F-44 sS2-,37-/UT NUMBER: Ogg -1170 L 3(-/6, �%t9- '4 -LL e , 4 0r� %� o 9'(City/State) (Zip) CITY/STATE/ZIP: • OWNER: QM MAILING' O/a7i / qt -'6 8/- x MAILING ADDRESS: P©/g - 3-70-7 LICENSE PHONE (Street) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH OF UNITS UNIT DESCRIPTION = AMOUNT DUCTWORK SYSTEM WOODSTOVE/INSERT GAS WATER HEATER HEATING EQUIPMENT <100,000 HEATING EQUIPMENT +100,000 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 & AIR CONDITIONER .HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER VENTILATING FANS BTU BTU 0-3 TONS 3-15 TONS 15-30 TONS 30-50 TONS +50 TONS EVAPORATIVE COOLERS TYPE I HOOD (PER 12' OR 12' TYPE II HOOD PTN. OF HOOD` CLOTHES DRYER RANGE GAS LOG MISCELLANEOUS (NOT COVERED UNLISTED GAS APPLIANCE <400 UNLISTED GAS APPLIANCE >400 USED APPLIANCE <400,000 BTU USED APPLIANCE >400,000 BTU AIR HANDLER <10,000 CFM AIR HANDLER >10,000 CFM ELSEWHERE) ,000 BTU ,000 BTU I 25.00 = 10.00 = 12.00 = 15.0Q = / 1.00 = 12.00 = 20.00 = 25.00 = 35.00 = 60.00 = 12.00 = 20.00 = 25.00 = 35.00 = 60.00 = 10.00 = 10.00 = 50.00 10.00 10.00 10.00 10.00 x 10.00 x 50.00 x100.00 x 50.00 x100.00 x 12.00 x 15.00 /0 • DO NOTE: MINIMU -PE !IT FEE IS $35.00 SIGNATURE (�rc,tieCtk 'h, C1.Q.L61-0-ali Spokane Cou vUUnty Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 SUBTOTAL $ /0 .00 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ S °O