1989, 09-29 Permit App: 89003697 Water HeaterMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: 6TJa Ua J 47)..0.1)A---, C
CITY/STATE/ZIP: 90}4(cU Ilk- 9970(4 PARCEL
OWNER: (iL . Lau'
!
• /d-0,)-/ r4
MAILING ADDRESS:
CONTRACTOR:
PHONE
7Mit-
(;Street) nn__
rXEIM - -7?0)1 1M -I �-e
MAILING ADDRESS:
NUMBER:
NUMBER: q?l -oq9/
y/State) (Zip)
--c-Ayr -37,24))-
PHONE
-37,2N)-
PHONE NUMBER: 41gc) -1J %0 C , . l%(
i f9zzo
(City/State) (Zip)
(Ci
LICENSE NUMBER:
,1o1
(Street)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER
OF UNITS
DESCRIPTION
X EACH
UNIT
= AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PI?ING (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 15.00
x 4.00
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 30.00
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
/n
NOTE:
SIGNATURE
MMINIMUM PERMIT PEE IS $35.00
Spokane Countyilepartment of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
OU