1994, 02-01 Permit App: 94000786 MechanicalMECHANICAL PERMIT APPLICATION FORM
61 �ckt., Aad 6-381 Information Worksheet
,JOB STREfET ADDRESS: 157-
C ITY/STATE/ZIP.
57
i;ITY/STATE/ZIP: 1. -(,, PARCEL, NUMBER:
OWNER: ` ' 'PHONE NUMBER:
' -- --
MAILING ADDRESS: -------
q (Street) (City/State) (zip)
CONTRACTOR: A.� �i LICENSE NUMBER:_---
. :. RHQNE NUMBER:' -73 " -----.
MAILING ADDRESS: 0• � fez,;
(Str et) ,, (citylState) (zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
xvgw:::,t,:nvrau.�17c,wsspgsaN
GAS WATER HEATER __ ; : `�
(aAS f?QUiPMNT;+�i0Q,01't�C.fl.:y} 3
GAS EQUIPMENT +100,000 STV DUCTWORK) fi
GAS PIPO
ING (A UTLETS <
,#..
s...,.<.
BOILER/REFRIG 1•-100M STU
BOILER/REFRIG 501-1,000M STU k ;-?
[301LER/RI=FRIG 0`1' °�'
BOILER/REFRIG +1,750M STU :3
w
HEAT PUMP & MIS. �o"'l'�����' r�• <..
HEAT PUMP & AIR CONDITIONER 3-15 TONS.-
HEAT PUMP 8 Alli CO%1131TIONi;.;CQIS
HEAT PUMP & AIR CONDITIONER 40,50 TO � r
H EAT PUMP $t AIR CQftl'I'11�1 ;( �
VENTILATING FANS .
"1
NOTE: MINIMUM PERMIT FEE IS $35.00
;t
NUMBER
OF UNITS
X EACH
UNIT
=AMOUNT
x 10.00 =
)(25.00 =
x 10.00 _
x 12.00 =
x 15.00 =
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
)(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 =
1117 .1771
�c
'
_
. 9.....
L
i .,.
_
_----
-
-- -
-----
_
-_
SUBTOTAL
$
PLUS: PROCESSING FEE
+$ 25.00
FOVAL.S; TOTAL PERMIT
FEE DUE
$
J•i
SIGNATURE ;
J pokline County PiyiSion 'of Buildings
West 1303 5r64dway Avenvq,5pQkanJ�, WA 99260 (509) 456-3675