1992, 11-18 Permit App: 92010106 Water Heater, PipingI , •
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: � a I )M AXING
CITY/STATE/ZIP: r? J a eNve ( PARCEL NUMBER:
OWNER: PHONE NUMBER:
MAILING ADDRESS:
CONTRACTOR: "1 -An
MAILING ADDRESS: c)
DESCRIPTION
(Street)
e'er? f2)
(Street)
(City/State) (Zip)
LICENSE NUMBER: //0/(-4/��/2 3 T
PHONE NUMBER:
Gu 71-
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
AN00DSTOVEiINS1
GAS WATER HEATER
GA:S;:EOUIPME!4T< 0esie 1111 INCLUDES Ss
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS' PIPING(El1Ql3T
BOILER/REFRIG 1-100M BTU
BOIL>=_RThEFR1GWri4.00M;B)il
BOILER/REFRIG 501-1,000M BTU
BOILER/AEPRIG.1:10041:L1 75011;13, U t' ";F
BOILER/REFRIG +1,750M BTU
HEAT.PUMP `& A)F3::ONOITION ER. 0-3'TQNS<s_%<`s<!
HEAT PUMP & AIR CONDITIONER 3-15 TONS
IiEAt:PU15:4# :1R;Q9,!ip.IT[OEIER<ifl 30 &at
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEATPUMP'S`AI OQNp;IT0*,0C4SO TONS m=r ',
VENTILATING FANS
SVAPO...347IV1=sO0.0LE1�.S:::;:::.;.,..<:,>:.:r.;:.>:
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
,TYPEII_HOOD
CLOTHES DRYER
sss
GAS LOG
MISCELLANEOUS:'(NOTOOVS.RED"EtSEWHt><<';r<`;
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED.GAS'AP.PLIANCE=y400000.ai.T4j=:>€si:a'>; 5=:
USED APPLIANCE <400,000 BTU
_.USED :APPLIANCE:240O;000:BT'U;
AIR HANDLER <10,000 CFM
AIR'HANDLER'>1,0,000::CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x12.00 =
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 =
/
/O
-7
-2--
Zx
SUBTOTAL
$ / R
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ ))-
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675