1993, 10-01 Permit App: 93009205 Water Heater, PipingMECHANICAL PERMIT -
APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: 2 0% 7 s S at) re rd
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: 8 rri Bat /c/w/n PHONE NUMBER: 72 /- Js' -s8
.2017 s Su-7r'se rd Sp e / &J `7206.
treet1 (City/State) (Zip)
r y LICENSE NUMBER: /UO%i TWA/ /9-
---'"d-PHONE NUMBER: 9c.,2,2- /DN' 9
oAc ,fe)4. 9c.)�3
(City/State) (Zip)
MAILING ADDRESS:
CONTRACTOR:
MAILING ADORES •
DESCRIPTION
& 1i /3'N9
(Street)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
0.6.004.1141,01U1.1.:,„; A0Q,STU:.(INCLUDES
GAS EQUIPMENT +100.000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
1 :R. l:G l
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
T: P M ONPmQNER ; 3;TONS , .
HEAT PUMP & AIR CONDITIONER 3-15 TONS
IMMIe 00KNEl7 ^ Q TONS;..<) . #
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
TYPE I HOOD PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
r
i`` y>�t�''Y�,•.S�;Q,'�
GAS LOG
UNLISTED GAS APPUANCE <400,000 BTU
USED APPUANCE <400,000 BTU
AIR HANDLER <10,000 CFM
s�16��k�/ Q.R. � •
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE 7 16kit
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x10.00 in
/0
x 12.00 =
x 15.00
x 1.00 =
/
1
x 12.00 =
x 20.00 .
x 25.00 =
x 35.00 =
x60.00 =
x 12.00 =
x 20.00 =
x 25.00 _
x35.00 =
x 60.00 =
x 10.00 =
x 10.00 on
x 50.00 =
x10.00 =
x 10.00 =
x10.00 =
x 10.00 =
x10.00 in
x 50.00 =
x100.00 =
x 50.00 •
x100.00 in
x 12.00 =
x 15.00 e
SUBTOTAL
$ //.Ou
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
3C 00
_ $
Spokane County Division of Buildings
West 102:Broadwav Avormo Snokann WA nn9nn rr.nr» Ar:n -1(17r.