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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