1991, 04-03 Permit App: 91001560 Water Heater MECHANICAL PERMIT APPLICATION FORM
Infoimatiorf Worksheet
JOB STREET ADDRESS: ( S 3 yO J, .,� ,, Rd
CITY/STATE/ZIP: = dam K PARCEL NUMBER:
OWNER: PHONE NUMBER:
MAILING ADDRESS:
(Street) is, (City/State) (Zip)
CONTRACTOR: 1 / L'A'S,46 1` ' LICENSE NUMBER: (,/ i? r � /`71/7?`tptint(
PHONE NUMBER:
MAILING ADDRESS: �V a>' T1 / 9'9,02
(Street) (City/State (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
00135TOVEIItSERT x 25.00 =
GAS WATER HEATER x 10.00 = /42-
GAS EQUIPMENTili00 000I TU(INCLUDES........ x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING(EA OUTLET) x 1.00 =
BOILER/REFRIG 1-100M BTU x 12.00 =
x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BO11_ER/REFRIG 1,0001:41,750M BTU;:`:' .` :: x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT=PUMP;&AIA 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 =
TYPEII HOOD • x 10.00 =
CLOTHES DRYER x 10.00 =
:RANG • x 10.00 =
GAS LOG
x 10.00 =
MISGELIiANEOUS. NOT-CO1/ERED ELSEWHERE - x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
:ULINS7EI' SAS APPLIANCE>400,000 BTU >>< :: x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
USS >``. :::;; > ;> ;..: : ...
........... ... ...... >:: �G« I.>:.;;1U:-;;:.>:.>:.>:<.:;>:.:.>:.»:.::.:;:::<:;:>:<:::>::>::>::>::>::»:_»> x100.00
AIR HANDLER<10,000 CFM x 12.00 =
;ATR HANDLE! >10, .CFM:.....';:::.<.:>;>>< >: <.: : ::;:: :>_:::::::'::: x 15.00 =
SUBTOTAL $ /d >
PLUS: PROCESSING FEE ; +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35." EQUALS:TOTAL PERMIT d>
FEE DUE = r
Li
SIGNATUR ' L J
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675