1993, 03-24 Permit App: 93001759 Water Heater, Piping(A501(2, G l r MECHANICAL PERMIT APPLICATION FORM
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y Information Worksheet
JOB STREET ADDRESS: 2- /6 ` ! ' 1 c
CITY/STATE/ZIP:5r Ke44
he 5 a PARCEL NUMBER:
OWNER: y (he=Joe) S PHONE NUMBER:
MAILING ADD SS:
1 75
E�Zo
D2E
vim 11333
(Street) (City/State)
CONTRACTOR: //// '/44w1-> ( LICENSE NUMBER:
PHONE NUMBER:81
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MAILING ADDRESS: Z 77� 3 1L6L6 5 4
(Zip)
4 /t? g 3
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DESCRIPTION GI
(Street)
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
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GAS WATER HEATER
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GAS EQUIPMENT +100,000 BTU DUCTWORK)
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.... .......::.�::::::.v:.:v::.::�v:.•.�.�.••••'•nv��••-•.•:::•JC{i•:4:•::.v.•:-.v:::hi•: ievxh{4:.4 :,},•,: }]CC:h{v::.v{•: }u%v\v.}:{.:v?v{•.
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
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BOILER/REFRIG +1,750M BTU
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HEAT PUMP & AIR CONDITIONER 3-15 TONS
....... .... ......... .
HEAT PUMP & AIR CONDITIONER 30-50 TONS
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VENTILATING FANS
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TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
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CLOTHES DRYER
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GAS LOG
UNLISTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
AIR HANDLER <10,000 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 =
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
x50.00 =
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 =
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SUBTOTAL
$ //,CO
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ 36x
Spokane County Division of Buildings