1993, 01-08 Permit App: 93000099 Water Heater, Piping fo
L./50a) . 4ck)c) .3 r
a bIcL MECHANICAL PERMIT APPLICATION FORM/7Z2
, �'
" C N L S , 6- Z / Information Worksheet
JOB STREET ADDRESS: /7 7 Z 2' 'OC,Kw e t I 59 5
l. ;.
CITY/STATE/ZIP: 2)j0on/ fl E (.01, 970g' PARCEL NUMBER:
OWNER: 7 2cS agew--/i S PHONE NUMBER: ,
MAILING ADDRESS: S/fr As ..4(3o ve
/ J
it !� (Street) (City/State) (Zip) '
CONTRACTOR: �/l 14I�to�Jl Y f i-.wt Lm.t7 L LICENSE NUMBER: tit WI T E pa: l Se C,J
PHONE NUMBER: S09 -�� �7.2.Z-SOO O
MAILING ADDRESS: tE I/fD mcuks-P tg . t'6. Seo. [.VJ4 L S2O 4 . .
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT •
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = •
2
.W �3 T::V . .00 NSEKi
x 5
GAS WATER HEATER / x 10.00 = /c, Gd
GAS EQUIi MENT(100,000 TU (INCLUDES,,.. ..... ...... x 12.00 -
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
x 1.00
=
l•°0
BOILER/REFRIG 1-100M BTU x 12.00 =
tOILER/r EFRIG 101 5ty0Ma 'TU':. ... €> >i:u*: <>`x,,,mi.... x 20.00 = •
BOILER/REFRIG 501-1,000M BTU x 25.00 =
W T fiti »iiiiil illi) x 35.00
Bt71LEI�/I�E�'I�IG•1�t�f�(��• 1,::.��.;:>;;:::�� .......... . .............. ..
BOILER%REFRIG +1,750M BTU x 60.00 = •
HEAT PUMP&•IIB CONDITIONER 01-3 TONS x 12.00 =
HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 =
HEAT PUMA' 1 I t NDITIONER 15.30 TO x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TNS .:....TONS x 35.00 =
HEAT UMP AI f CONPITIONEI 50 TON >' >1<1 ><r <'> ' x 60.00 =
VENTILATING FANS x 10.00 =
EVAPORATIVE 05.. .. .. ........ :: ' ::. �;;:<�:«..:::
x 10.00
TYPE I HOOD (PER 12' OR 12' PTN. CO HOOD) • x 50.00 = '
:ii•'f.:t:'4::4:4::>:ii::•}};iG:4:•i:4i::4::f;::•.�::•:.�::::::•iiii::•i:::•::ii:i::
TYPE II H�i�. :..:...�.:::.<...�.::.>:;...........«;::>.>:;;<:.>:»:.:>;>:.;:.>:.:.>::.:;'.' .::::.:::.::.:: ::
x10.00
CLOTHES DRYER x 10.00 =
ipANGEiiiiiniiiiiiiiiii*:*,:moi:i:i*imismia:mioi:i*i:imi:::iswisisi:immoioi:immi:::::i*.:
x 10.00
_
GAS LOG x 10.00 =
MISCELLANEOUS(NUS'COVERED':i[4.009. ERg1> x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
>4 B <> >«>> » x100.00=
ULiNSTEf .GAo 1APPLIANOti$ .0i).,OOHIU.;::.;;:.>::.;:.:>:,;;:.;:.>:.;:;:;;:.::
•
USED APPLIANCE<400,000 BTU x 50.00 =
USED APPLIANCE (10;fSp(I:StU........m>>`>`a»>i»i >m... .....:: x100.00
=
AIR HANDLER<10,000 CFM x 12.00 =
x15.0 0
SUBTOTAL $ //,oo
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
C FEE DUE _$ 6 co
S
IGNATURE c4-(20--e* -
Spokane County Division of Buildings
• West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675