1992, 11-23 Permit App: 92010319 Water Heater, PipingMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: 5 8 /02 if? i
CITY/STATE/ZIP:S�b.4oi'to CAJ A < 9Fz 12'
OWNER: LArry Fano
MAILING ADDRESS: .SA*A1 fI A -S Aeoaf
(Strelet) (City/State) (Zip)
CONTRACTOR: `A SiI.1 O VI u.KA 1111 L LICENSE NUMBER: U Ni T E IPI ! SB cd.
/ / PHONE NUMBER: SO9 - 7..22.- 5-00 O
MAILING ADDRESS: tE llfte2 m�,St a 1c 7± Styx. LQJ 4 7f-244.
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
PARCEL NUMBER:
PHONE NUMBER: %ZV 339e
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER::::. :........ .......
:GAS E UIPMENT 1b0►000 BTU (INcLUDEs:...:
GAS EQUIPMENT +100,000 BTU DUCTWORK)
Ia/�� pIP NG.(�A.pU• Lr=T) .:....... . _........
BOILER/REFRIG 1-100M BTU
`:0 II4RII 0..6:041 i!F5ooM t
BOILER/REFRIG 501-1,000M BTU
...........:.::...:. .
.BOILER/REFRIG 1,0001-1.,7"50M BTt1 >< >>< <>>
BOILER/REFRIG +1,750M BTU
::HEAT PUMP & /IR CONDITIONER O.. $ TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
::HEAT PUMP &,fir=c.CONDITIONNER 15 30 ONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
EVAPORATIVE COOLE 5
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
�:V � �ii::�� �::� �%'��!: et2i,:::i;';i:i;ti:iC}:iy: � ri::::{:•{vi:j: :;'+,i:}{S+ii};:i>ii: �::i :ii;:i;>.: ii:::::i::::.:
CLOTHES DRYER
GAS LOG
'MIG • NE•t;lus- COVg1=iED ELSEW pt
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED•
400 O0O BTU...:
USED APPLIANCE <400,000 BTU
...............
.........:......:.............................:.
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x10.00 =
x 12.00 -
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x35.00 =
x 60.00 =
x 12.00 =
x 20.00 -
x25.00 =
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 =
x50.00 =
x100.00=
pc -r
/,.
x 12.00 =
x 15.00 =
SUBTOTAL
$ WO
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
oa
=$36-
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675