1989, 09-28 Permit App: 89003660 Water HeaterMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: E. //9/5- Po M dapes y. D4-•
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CITY/STATE/ZIP: Sit o/Ga a..r live PARCEL NUMBER:
OWNER: To/L Mt6a1-4 ela,..
MAILING ADDRESS:
seta... r
PHONE NUMBER:
(Street)
CONTRACTOR: /-e,, ,,. S.aCoM S heemil
ski
MAILING ADDRESS: /3 in c/ S/ ct
(Street)
MECHANICAL
DESCRIPTION
eQ",s/eo
1
g"--9 S--6 /1», w -3t $-4.k
(City/State) (Zip)
LICENSE NUMBER: /= OU ASH/11 3 hi! G -
PHONE NUMBER: (, - e/ / 9 3
u d wq. 990i/
(City/State) (Zip)
WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
= AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PI?ING (5 OR MORE. EACH:)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)
UNLISTED GAS APPLIANCE <400,000 BTU
UNLISTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
1
x$10.00
x 25.00
x 10.00
x 12.00
x 15.00
x 4.00
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
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
/n .00
NOTE:
SIGNATURE
MINI UM PERMIT FEE5.00
%L4--C.y
SUBTOTAL
$ /0.06
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 3r00
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675