1992, 11-19 Permit App: 92010245 Water Heater, PipingMECHANICAL PERMIT APPLICATION FORM
/Information WorI Sheet
'
JOB STREET ADDRESS: 3 ) - 5 /e-'-'
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: Pori _5 /4a ' s4 64.v-lek- PHONE NUMBER:
MAILING ADDRESS: S,zt-i-2
/� c (Street)
CONTRACTOR: # (A -s �/ �'(
MAILING ADDRESS: .?Z 4" & t '1/B)('
(Street) (City/State)
DESCRIPTION
92y -- 2`25-C'
(City/State) (Zip)
LICENSE NUMBER: f7(- ,5.5A/Oke) /2/(
PHONE NUMBER:
'77?2-a
(ZIP)
MECHANICAL WORK
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
0::M :. '
BOILER/REFRIG 501-1,000M BTU
:;+'
aii
BOILER/REFRIG +1,750M BTU
{1..!!r:RJli:;}?•:Y•��tt::':::S:3�T::S•M•Ml
HEAT PUMP &AIR CONDITIONER 3-15 TONS
::c:e......:.:i ::r:::w.��.�r:,•ra 3�r ..... rt�r. ....w.r.......... ,.;.:,,�:.�;;r'::?;::,'•r'.• :.'•;:
HEAT PUMP & AIR CONDITIONER 30-50 TONS
CON
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
............................................
GAS LOG
..........................
•
UNLISTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
AIR HANDLER <10,000 CFM
<ari�wr:iw'i:iY:;;:: :iit:Swc:•w•':;ia i'r►:
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x10.00 =
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 =
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 =
I
/D!v-e
t
SUBTOTAL
$ //tom
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ ,3 •de
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675