1994, 03-23 Permit App: 94002330 Water Heater, PipingMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: S 5 u o
CITY/STATE/ZIP: 5 r<,. 77 /..1 PARCEL NUMBER:
OWNER: 9 a-tv (7---n..24-&,/ PHONE NUMBER: 70"/ . S 2V 1
MAILING ADDRESS:
674-z3
46(0
15181- cis!/
// (Street)
CONTRACTOR:�lr.-r{) / /4/2 -' y
/q
MAILING ADDRESS: F .' In 3 'PA -c
(Street)
DESCRIPTION
• (City/State) n (Zip)
LICENSE NUMBER:N//.p ( a HA i 76 /
PHONE NUMBER:
(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).:';l';.:.::;:::
BOILER/REFRIG 1-100M BTU
801LER/REFRIG,101400M:BTU.:::
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG t,000t-1,750M BTU ,...:.°
BOILER/REFRIG +1,750M BTU
HEAT Pt1MP &:AIR CONDITIONER, 0-3 TONS.'
HEAT PUMP & AIR CONDITIONER 3-15 TONS
:NEAT RUMP'& AIRtONDITIONER15-30,TONSa :: :(
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP, &'AIR CONDITIONER+50
VENTILATING FANS
EVAPORATIVE,COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
.TYPE II HOOD::;;
CLOTHES DRYER
;RANGE .
GAS LOG
MISCELLANEOUS,(NOT; CO).1ERED. ELSEWHERE: _.:
UNLISTED GAS APPLIANCE <400,000 BTU •
ULINSTED GAS,APPLIANCE>400 000 ETU ;
USED APPLIANCE <400,000 BTU
`USED APPLIANCE>400,000'BTU
AIR HANDLER <10,000 CFM
AiR HANOLE14>10,000.CFM;
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
_eL 2Q --A-1±
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00 =
x10.00=
x 15.00 =
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 =
x25.00 =
x 35.00 =
x60.00 =
x10.00 =
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 =
/aUc
/,Up
SUBTOTAL
$ /1.00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ 26.- 00
Spokane County Division of Buildings
West 13L. wiway Avenue Spokane, WA 99260 (509) 456-3675