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1992, 08-20 Permit App: 92006660 Water Heater, Pipingi\ o-74• 05� �V,s�.6 S 5 a`1c\•5 �,- `Si� Cc�> p� 5 MECHANICAL PERMIT APPLICATION FORM \) t, I Information Worksheet JOB STREET ADDRESS: Sy/0 L .ADO/c‘. CITY/STATE/ZIP: Spbh y\ E- , 1A )19 RC ad q PARCEL NUMBER: OWNER: IRk ch qfd Sams S PHONE NUMBER: MAILING ADDRESS: 8 q I L" !. A.DO Spa canc, l on `'79;.101 (Street) (City/State) (Zip) CONTRACTOR: ltO!-} a -WS' 4 c4 -F-; ynet • LICENSE NUMBER: L3yATT NC. - l o(GH d PHONE NUMBER: 535 -9461"7 MAILING ADDRESS: G La3/5 :Kon Spokc„no. 3 ( i)ycl 99aI I - 140 2 - (Street) (City/State) - (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) iWOODSTOVE/INSERT ......?:;';::i7 ,;'::':r;.;°i::' . GAS WATER HEATER GAS;EQUIPMENT <100,000 BTU;(INCLUDES .. ";:i GAS EQUIPMENT+100,000 BTU 'DUCTWORK) GAS,PIPING (EA OUTLET) BOILER/REFRIG 1-100M BTU :BOILER/REFRIG 101-500M BTU:":..r`:c'i.`.' BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG 1,0001W1,750M.BTU:: i` 'i.;:.:':r::: BOILER/REFRIG +1,750M BTU HEAT PUMP,.&,AIR CONDITIONER 0-S TON5". C ;: ::' HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT'P,UMP:.& AIR CONDITIONER 15-30.TONS :.:: : : HEAT PUMP & AIR CONDITIONER 30-50 TONS ;HEAT•PUMP & AIR, CONDITIONER +50. TONS VENTILATING FANS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPE IIHOOD. • CLOTHES DRYER 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 >400,000 BTUr;f;,.;`?.",,: AIR HANDLER <10,000 CFM ;AIR _HANDLER >10,000CFM:;";;....;'.`iri:;::;'_::: • NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE�G�. GSC Spokane County Division of Buildings West1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 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 = x35.00 = 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 = / - /O. 0(l / /. 0 0 SUBTOTAL $ -/ /. 0 0 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ 3c.00