1992, 03-13 Permit App: 92001500 Pool HeaterMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: 02 S f%S ,S Y' er��
CITY/STATE/ZIP: 5/#3,424,---e
OWNER: 46 h
MAILING ADDRESS: S4/ 'A"`{
PARCEL NUMBER:
PHONE NUMBER:
9'2t .2763
(Street) (City/State) (Zip)
CONTRACTOR: //c z', LICENSE NUMBER: iP/i9S.5i2/D'a92k'
PHONE NUMBER: 922 - 3 7o 5'
MAILING ADDRESS' 3"/( A) `at°'1 , 2e • 5e4W, 99-zo 6
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
W STOVi t'1.NSER' ' <>::<>;::;.<::>:::::<:::::>::<:;>::>:::.>�:M:<:::
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
lS`f?1: litit
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 3-15 TONS
f l'4'f l > 15-30 T S
HEAT PUMP &AIR CONDITIONER 30-50 TONS
VENTILATING FANS
•
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
itair
GAS LOG
•
F.T�TM?7l:TR!!}TMi\R:. T)l l;:•.l•ii'fI..M.i�:�S:T. is TRTRTR.RI...
UNLISTED GAS APPLIANCE <400,000 BTU
•
USED APPLIANCE <400,000 BTU
•
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x12.00 =
x15.00 =
=
x 1.00/
x 12.00 =
x20.00 =
x 25.00 =
x35.00 =
x60.00 =
x 12.00 =
x20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x50.00 =
x100.00 =
x 12.00 =
x 15.00 =
i
4.5", 012
I
, v✓
SUBTOTAL
$ )4, .oto
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
Cr 4 av
= $
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675