1991, 07-26 Permit App: 91004539 Water HeaterJOB STREET ADDRESS:
CITY/STATE/ZIP.///►
OWNER l' - 1 e9-0 ) l J.c
MAILING ADDRESS: 0 /
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
PARCEL NUMBER:
r
PHONE NUMBER: 9a -,5-/3o9
(Street)
CONTRACTOR:
MAILING ADDRESS: ADDRESS: 1O16 "() '
4ag-ti,o/aM�v
(City/State) (Zip)
LICENSE NUMBER: 19-10_ --'S _ 123 7;yo
PHONE NUMBER: WY? -//9
(Street)
ll ff e, /&6'L , (?VP()
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
DESCRIPTION
= AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PINING (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 &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS _
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
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
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.08 =
x-.`
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 =
(0 QO
NOTE:
SIGNATURE
MINI U E T FEE IS/� $35.00
SUBTOTAL
$ /Q' on
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
nO
= $ .� `-
Spokane C ty Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675