1993, 06-01 Permit App: 93004160 Water Heater, PipingMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS:/�/.13a1 /Y7/3 r
CITY/STATE/ZIP: 4Doc--.4>, iQa 977/6, PARCEL NUMBER:
0
OWNER: PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: trtikJ AL.) PIM (1-i3 >' '? LICENSE NUMBER: XN LA n A 1/ 673 G v
J� PHONE NUMBER: S� - 0-(-700
MAILING ADDRESS: �O(D<
o i.sCki;), spo fri' iciA 99.20
(Street) (City/State)
MECHANICAL WORK
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
:WOODSTOVE/INSERT::.'. `::i':
GAS WATER HEATER
GAS. EQUIPMENT:ci00,000rSTU (INCLUDES::
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS plf?INGAA O,O7G; I i;:..
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG')1,Oi 500M:BTU;:::;.._'..
BOILER/REFRIG 501-1,000M BTU
BOI LER/REFRIGA000.11;75OMBTU_;?_
BOILER/REFRIG +1,750M BTU
HEAT PUMP°$( AIR CONDITIONER 0-STONS:>'.
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP &:AIR: CONDITIONER 7E-30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT:PUMP,;&'AIA CONI ITjONER +30 TONS: ` <
VENTILATING FANS
:EVAPORATIVE.CQOLERS
........::.:.:...
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
;TYPO(
CLOTHES DRYER
GAS LOG
MISCEL LAN;ECUS':.(NOT:::COVERED?ELSEWHER>
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED`:GASAPPLIANCE°_>400 000.0111:;:::
USED APPLIANCE <400,000 BTU
USED;' APPLIANCE:>4.00x000:ETU _:::
AIR HANDLER <10,000 CFM
:AIR HANOL.ER;:>10;000:CFM::
II
NOTE: MINIMUM PERMIT FEE IS $35.00
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
/
x 10.00 =
x 12.00 =
x 15.00 =
J
I
x 1.00 =
x 12.00 =
x2000 =
x 25.40 =
x 35.00 =
x 60.00 =
x 12.00 =
x20.00 =
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 =
x50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 35-(x)
SIGNATURE
Spokane County Division of Buildings