1992, 10-07 Permit App: 92008561 Water HeaterJOB STREET ADDRESS:
CITY/STATE/ZIP:
OWNER:
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
? 11 Y� ViNCE'c LCs
PARCEL NUMBER:
PHONE NUMBER:
kI, AB ('g BCU
0/l�f
t („)
(ZIP) v\
MAILING ADDRESS: C b In ) t C r j i_
(Street) Ver-
CONTRACTOR: (YIO EVC l\, �. \ 5 r>- LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
„WAOD:STpyEltNSK_,1
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
ighSc P),E'I IMA:L,cwi':c
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
p1LE# /a G ,00 Ic 750tv1 > 7
BOILER/REFRIG +1,750M BTU
•Fl ..re 1.M.P„& malgf7 blig sim ;TANS:
HEAT PUMP & AIR CONDITIONER 3-15 TONS
H A'P I PE<&ATECG;ONQITiON 14;1 13:61 NS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
[0:#115::0.RA t7V"E"p0 LESS
TYPE I HOOD (PER 12' OR 12' PTN. OF -HOOD)
TYPE I I ;:C.1 `' , t<
CLOTHES DRYER
GAS LOG
M$CEL ANEQ;001:0T;Cq 1 tE17>1=tS,t WF1
UNLISTED GAS APPLIANCE <400,000 BTU
JLINSTErXGASAPPIiIANCEt tOq;tlUO'»TlJ
USED APPLIANCE <400,000 BTU
;USED Mtg.IANGEnAWOO 8'T'(J`
AIR HANDLER <10,000 CFM
WIIAN DLERSyO0.p6.Gf
NOTE: MINIMUM PERMIT FEE IS $35.00
- (LP)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x20.00.=
x 25.00 =
x 35.00 =
x60.00 =
x 10.00 =
x 10.00 =
x50.00 =
x 10.00 =
x 10.00 =
x10.00 =
x 10.00 =
x10.00 =
x50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 '_
•
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675