1992, 09-21 Permit App: 92007864 Water Heater, PipingI3 e 1
r 0 LALk
�J(2, \b/ 6 MECHANICAL PERMIT APPLICATION FORM Date : C/��
uCU� \ Information Worksheet a- -1E(04
JOB STREET ADDRESS:
33i 0 etc. j2
CITY/STATE/ZIP: 4bfZaY_ (A) q la(
OWNER: 1---eA. R,D,(e
MAILING ADDRESS:
(Street)
Ripley's Plumbing, Inc.
CONTRACTOR:
PARCEL NUMBER:
PHONE NUMBER: / co Se it/
(City/State)
LICENSE NUMBER: RIPLEPI107B6
PHONE NUMBER: 509-535-1919
(zip)
MAILING ADDRESS: 4104 E Pratt Spokane, WA 99202
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
.GAS PIPING'{EA_QUTLET) -.. -::.:
BOILER/REFRIG 1-100M BTU
<BO1. REI=RIG Tt3I M RTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR .CONDITIONER U 3 TONS:::::: '`'
HEAT PUMP & AIR CONDITIONER 3-15 TONS
;HEAT PUMP:& AIR CONDITIONER 15 30 TONS
HEAT PUMP
& AIR CONDITIONER 30-50 TONS
HEAT:=PUMP & AIR:CONDITIONER>+50:.TONS < ':::
.............................................................................................................
VENTILATING FANS
O COOL S ......... .......................
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE<II H D:..
CLOTHESDRYER
:........................................................................
<RA
GAS LOG
: :.v�v:vnsn•.}?•: x: n•:.vxnv{.v:: �i:.vv..:
MISCEU. S (NO cOVEREo wH E
UNLISTED GAS APPLIANCE <400,000 BTU
UlIt STD AS AP't fANCI" OU,t BT11
USED APPUANCE <400,000 BTU
ry�ii"rvm;
F: .i <: .ny-ni���v�.}:
w,SSCc�YiL'J: ,.3:...f. :+v3..'�\.rw�tFtirn'vET.Lt.'tr�
AIR HANDLER <10,000 CFM
MR tiANpi)*l '`y 01000' 1=M' < ` Y
NOTE: MINIMUM PERMIT FE S $35.00
SIGNATURE
(zip)
NUMBER X EACH
OF UNITS UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =-
x 1.00 =
x 12.00 =
x20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x20.00 =
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 =
x10.00 =
x50.00 =
x100.00 =
x50.00=
x100.00 =
x 12.00 =
x15.00 =
I
10,t)-0
-
1
1
1.00
SUBTOTAL
$ /i.04)
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ 36-0°
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675