1992, 06-11 Permit App: 92004248 Water Heater, Piping11.059 2-C)\ 42-Lk76
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MECHANICAL PERMIT APPLICATION FORM
inforration Worksheet
JOB STREET ADDRESS. E )7(5 ((-S s t ON
.7 c)
CITY/STAT IP: Po 9 9 O/ G' PARCEL NUMBER* R - a 5 Z I
OWNER:
MAILING ADDRESS: 6
PHONE NUMBER.
(Street)
CONTRACTOR: /C LEF-e 1
MAILING ADDRESS' - 3/4)D. c
(City/State) (Zip)
LICENSE NUMBER: 2ICHA2+t15o M q
PHONE NUMBER:
SPo 9"7.07
DESCRIPTION
(Street)
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
•
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
4 ?PINS
:....... :... ry,.:v{riv: }.tiA•.'J:l
ft'4•i$v{,:.?:{:{�:f
BOILER/REFRIG
1-100M BTU
1W.xaeil.�.. : ��'.Y.:.rwytrs:•,vo:.�x•.r:.::.{a{.y./si.•ia;:•.4�•? : •- fy:::..:{r:•::v:..l ..x:..;f,lh{:w:•:{:'r
BOILER/REFRIG
501-1,000M BTU
1414024:::..,
am
BOILER/REFRIG +1,750M BTU
• :1), � �)til.l����y'i'�...:.::•�:x.:-::.x...:::.
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
�i ?'^ Y• 4• ?' k C$A% •'" 1.'F`: b ?{•' •ii:'V'•
vv ::::::::::::: n xu::.v..v :., w..•.•. r:. :... u. ...v,.::x::.:•.+v r :.. x, .r :.::.:..
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
i�'�'{,:v}.:�.•�nv.ni?+:C•.4: ii::i$:{.}.:.::::n:i'}}Ri:v .: .: }\;•X4?:Yiv:?�%.::: ii$.'•$:
CLOTHES DRYER
::i `+}:1j$'vr.:•::.yi.: }y },,:}{••.v.�•'•. fn•::4.:r •::: x.:v: A:.•.w::nx{•:::.h
GAS LOG
UNLISTED GAS APPLIANCE <400,000 BTU
t•(.•,}�!t
5ifb?,14'•.4V':;"FSllyRyyy::::::<.:::.•::`::::{i:::::%f::�': ?::::::
USED APPLIANCE <400,000 BTU
}y:
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00 =
x10.00 =
x12.00=
x 15.00 =
x 1/x.00
x 12.00 =
x20.00 =
x 25.00 =
x35.00 =
x60.00 =
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 =
x50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
1
/o• o0
)
/2•CS0
,
it
SUBTOTAL
$ 'aa , (1,0
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_$ 17 •OO
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane. WA 99260 (5091458-9875