1993, 05-12 Permit App: 93003436 Water Heater, PipingMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: E 81'8 Si P e
CITY/STATE/ZIP: Spa
)(A h a LAJ1ti , `f g 212-
OWNER:,
1'LOWNER:, CV C 1 R1/4./4t
MAILING ADDRESS: .'A
PARCEL NUMBER:
PHONE NUMBER: i"e yJo
(Street)
CONTRACTOR: C' i 1- 11(u. vti
(City/State) (Zip)
L LICENSE NUMBER: L {. ALT T E -
PHONE NUMBER: S69 - -,540
MAILING ADDRESS: V S10, mc&s- cIS at'ao Sy6. Lei/4 5-245
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
OD >5!
GAS WATER HEATER
GAS.EQU1PMENT <100100V:+f#V(INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
p f n.v. n. •.k•.
GAS PIPING (EJB OUT
BOILER/REFRIG 1-100M BTU
l�OILEf /REFRIG lOi-SdOM STU
BOILER/REFRIG 501-1,000M BTU
EOILERJfEFRiG 1 O 0 ,750MAl ;TI
BOILER/REFRIG +1,750M BTU
;HEAT PU•MP AIR CONDmONER 0I 3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
,HEAT PUMP &.AIR:eONDITIONE R 15.6. TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HE .AT PUMP & AIR CONDITIQNER X50 TOIJS
VENTILATING FANS
EMAP: R TIVE. h O 1 E= S
O O.
C
A R
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) •
if.-::}:`.:; :;:i::: ;.:::. : i::;:;i; :n::•.ii:vii :i:: p:•::..:..:::hii:
4'.
CLOTHES DRYER
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEIIVI ERE ,a
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED CAS APPLIANCE >400 ODU:,:«h
"'USED APPLIANCE <400,000 BTU
AIR HANDLER <10,000 CFM
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00 =
x10.00=
x 12.00 -
x 15.00 =
x 1.00 =
x 12.00 =
x20.00 =
x25.00=
x 35.00 =
x 60.00 =
x12.00 =
x 20.00 _
x25.00=
x 35.00 =
x 60.00 =
X 10.00=
x10.00 =
X 50.00 s
X 10.00 a
X 10.00=
X10.00 s
x10.00 =
x 10.00 =
x50.00 =
X100.00 =
x 50.00 _
X100.00
x12.00_=
x15.00 _
4100
/ Cad _
-
.. ... ..:....
, --_.. .
_.�}--...- ,_ - ..-
-x10.00
_. -
--_... ..
---._ •
-
• -
,'77:.74^-3
SUBTOTAL
$ I1. o0
PLUS: PROCESSING FEE '
+ $ 25.00
EQUALS:. TOTAL PERMIT .i
FEE DUE '
a' -
=$ 34,0
sic-NA:Tuna' "s
Spokane County Division of Buildings , -
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 •