1989, 09-20 Permit App: 89003496 Water HeaterMECHANICAL PERMIT APPLICATION FORM
Inf// mst on Worksheet 6
JOB STREET ADDRESS: '7Kp-� �. . % ', > ` q�/,
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CITY/STATE/ZIP: D I�c ht.k._ I) PARCEL NUMBER: 6 a5` l -Co 7 o5
OWNER: 6�% PHONE NUMBER: !a-? '767/i
MAILING ADDRESS: 44 7 Ge6 44 ')
(Street) (Ci y/State)_(Zip)
CONTRACTOR: a)14- - LICENSE NUMBER: ce -cur
PHONE NUMBER: *?-11.2 - 6 Z!�
MAILING ADDRESS: T0.--1-3, % I (�t�G�- 6192 76
(Street) (Ci y/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION OFFUUNNITS XUN UNIT
=AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PIVING (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 15.00 =
x 4.00 =
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=
x 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 =
NOTE: MINIMUM PERMIT FEE�IS $35.00
SIGNATURE (104-- ( GC%a n .
Spokane County Department of. Building` and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE