1993, 02-10 Permit App: 93000754 Water HeaterMECHANICAL PERMIT APPLICATION FORM
//
Information Worksheet
JOB STREET ADDRESS:// �IV YLaq /�A✓Ll /f'^•
CITY/STATE/ZIP: 7. <'wti C/. V9-2/4 PARCEL NUMBER:
OWNER: / vk I' a (✓4 t/ PHONE NUMBER: 9-2 d' S ii
MAILING ADDRESS: A/ `' 0 ,L _c K %'/
(Street)
CONTRACTOR:
MAILING ADDRESS:
Spo/F,t 'A.
_ (City/State)
LICENSE NUMBER:
PHONE NUMBER:
99z/c
(Zip)
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION •
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS
WOODS!UV;E(0$E1
GAS WATER HEATER
rattQl rginEN t1QU tl001 T1.A t tJCaES
GAS EQUIPMENT+100,000 BTU DUCTWORK)}
BOILER/REFRIG 1-100M BTU
NUMBER
OF UNITS
Bpa > f?I1i I IG °01,w Otk...T.,
BOILER/REFRIG 501-1,000M BTU,;
italWatgigabiglitialsA
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER '3-15TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS' 't
IRWAi1!Iv[Py&?AtRgO(7NDIg(3N I . 5ff ,O
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD):'
CLOTHES DRYER
n.
GAS LOG
151000.411 0111PAINgatiC
UNLISTED GAS APPLIANCE <400;000 BTU
USED APPLIANCE <400,000 BTU
1.04:.ite 1 tANGg.MIS@OQ
AIR HANDLER <10,000 CFM
tAIR;_HANpI tR1.o 4gOC1
NOTE: MINIMUM PERMIT FEE IS $35.00
X EACH
UNIT
x10.00 =
x 25.00 =
x 10.00 :_
x12.00;=
x 15.00 = `
x 1.00 '_: .
x 12.00 =
x20.00=.'.
x 25.00 =
x 35.00 =:::.
x 60.00
x12.00.'!=r, rr
x 20.00;
x 25.00'.=
x 35.00 _'
x60.00= `
x 10.00
x 10.00 _;`..
x50.00=
x 10.00.=.;
x 10.00 ='
x 10.00:'=
x 10.00
x 10.00
x 50.00 =
x100.00.= -
x50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
PLUS: PROCESSING FEE
EQUALS: TOTAL PERMIT
FEE DUE
=AMOUNT
$
+$ 25.00
SIGNATURE 7�--1/
Spokane County Division of Buildings
West 1103 Broadway Avenue Spokane. WA 99260 (5091456-3675