1992, 11-05 Permit App: 92009772 Water HeaterMEGNANU.AL rttl'YH! P.rru,Kigun runsvi
Irfornlation Worksheet
JOB STREET ADDRESS: 1 /;f `A IDQv
CITY/STATE/ZIP•
r_L 62/:,- PARCEL NUMBER:
OWNER : 3 (/
MAILING ADDRESS: 2/ ? -1,C`.P X /� WW,/G�/��� 9
(Street)
CONTRACTOR: �en v, /
MAILING ADDRESS: V(9J . ��>'7
(Street)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
l
PHONE NUMBER:L.0?-0'?(--5-134Y
7
(City/State) (Zip)
LICENSE NUMBER: -5 A1/
PHONE NUMBER :11 - 5M
//jj
(City/State) (Zip)
DESCRIPTION
= AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 --4 OUTLETS)
GAS PIING (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 & AIR CONDITIONER 0-3 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
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
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 1
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 =
Y 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 =
/D, oo
NOTE: ' I 14. ; IT FEE - $35.00
SIGNATUR - �r AV�
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
j
Sp i an. . ounty Department of Building and Safety •
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675