1990, 09-12 Permit App: 90004525 Water Heater, Piping ` MECHANICAL PERMIT-APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: S, 5 <=I z s ST.'N 0 u4/4.1
CITY/STATE/ZIP: nr PARCEL;, NUMBER:
OWNER: l' k(.1.,?, /� e`FG/N PHONE NUMBER: 927-.0 03 7/ 924-ZfZj'
MAILING ADDRESS: s, 34 25 SvNt ,,,v Spc)(;‹/a-r✓‹,
(Street) (City/State) (Zip)
CONTRACTOR: Si14 Pei LICENSE NUMBER: S N4PPGP c l o 9 c-3
n f PHONE NUMBER: 4b 7- t� 42g
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MAILING ADDRESS: 752-0 4/j ')+ = PC) 'VS 99 .O7
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM x$10.00 =
WOODSTOVE/INSERT x 25. 00 =
GAS WATER HEATER f x 10.00 =
HEATING EQUIPMENT <100, 000 BTU x 12.00 =
HEATING EQUIPMENT +100, 000 BTU x 15.00 =
GAS PIPING (EA OUTLET) x 1.00 =
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12.00 =
REFRIG 101-500M BTU x 20.00 =
REFRIG 501-1,000M BTU x 25.00 =
REFRIG 1,001-1,750M BTU x 35.00 =
REFRIG +1,750M BTU x 60.00 =
HEAT PUMP & AIR CONDITIONER 0-3 TONS _ x 12.00 =
HEAT PUMP & AIR CONDITIONER 3-15 TONS _ x 20.00 =
HEAT PUMP & AIR CONDITIONER 15-30 TONS _ x 25.00 '=
HEAT PUMP & AIR CONDITIONER 30-50 TONS _ x 35. 00 =
HEAT PUMP & AIR CONDITIONER +50 TONS _ _ x 60.00 =
VENTILATING FANS x 10.00 =
EVAPORATIVE COOLERS x 10. 00 =
TYPE I HOOD (PER 12 ' OR 12 ' PTN. OF HOOD) x 50. 00 =
TYPE II HOOD x 10.00 =
CLOTHES DRYER x 10.00 =
RANGE x 10. 00 =
GAS LOG x 10. 00 =
MISCELLANEOUS (NOT COVERED ELSEWHERE) _ x 10.00 =
UNLISTED GAS APPLIANCE <400, 000 BTU_ _ _ x 50. 00 =
UNLISTED GAS APPLIANCE >400, 000 BTU _ x100. 00 =
USED APPLIANCE <400, 000 BTU x 50.00 =
USED APPLIANCE >400, 000 BTU x100. 00 =
AIR HANDLER <10, 000 CFM x 12 .00 =
AIR HANDLER >10, 000 CFM x 15. 00 =
SUBTOTAL $
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT
NOTE: MIN UM PERMIT FEE IS $35. 00 FEE DUE = $
SIGNATURE
Spo ne County Department of Buildingg and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (5 9) 456-3675