1993, 02-05 Permit App: 93000643 Water Heater, PipingJOB STREET ADDRESS:
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
c 6/s
CITY/STATE/ZIP: , )j ft LC) `"! _ a PA CEL NUMBER:
OWNER: 61 (a +k 1 d e r )
MAILING ADDRESS:
PHONE NUMBER:
•
// (Street)
CONTRACTOR: are en O Q
MAILING ADDRESS:
DESCRIPTION
E
c.5/6 7't
(Street)
(City/State) (Zip)
LICENSE NUMBER: ,A0o2C_0-71/9 (k_Z
PHONE NUMBER: _6(g1S-
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT.
GAS WATER HEATER
GAS EQUIPMENT:<100,000 BTU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 101-500M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,0001-1,750M BTU
BOILER/REFRIG+1,750M BTU
HEAT.PUM,P & AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT.'PUMP &AIR CONDITIONER 15-30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT: PUMP & AIR CONDITIONER +50 TONS
VENTILATING FANS
EVAPORATIVE COOLERS .
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE HOOD,'
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS'(NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS 'APPLIANCE>400,000 BTU
USED APPLIANCE <400,000 BTU
USED•APPLIANCE X400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER'>1,0,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
zir
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x35.00 =
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 1,0.00 =
x so.0o =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
/L)_ A
N.,
`, 4
$ IC. a/
+ $ 25.00
SUBTOTAL
PLUS: PROCESSING FEE
EQUALS: TOTAL PERMIT
FEE DUE
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= $ V�
Spokane County Division of Buildings
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