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1991, 07-29 Permit App: 91004563 Water Heater MECHANICAL PERMIT APPLICATION FORM /(_,6 Information Worksheet JOB STREET ADDRESS: o2 -�' ' S S CITY/STATE/ZIP: - ' PARCEL NUMBER: OWNER: % 1t -y,) PHONE NUMBER: ? F:4 MAILING ADDRESS: r�!_ (Street) (City/State) (Zip) CONTRACTOR: 77/ o_ 1 � PA/1 t yASA LICENSE NUMBER: lul 'i._ PHONE NUMBER: MAILING ADDRESS: �- z;X_ � :,}� fit,i.' �? /� `;-)j-7.12e) (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = WOQDSTOVE/INSEIT x 25.00 = GAS WATER HEATER ,/ x 10.00 = /y) �J GAS QUIPMENT................................... < 0000 BTU(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 = BOILI/REFRIG (1-500M BTU x 20.00 = BOILER/REFRIG 501-1,000M BTU x 25.00 = BQILERIRI=I<RIG 1. 0 1 1,750M BTU x 35.00 = BOILER/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 = TYPEII 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 = ULINSTED GASAPPLIANCE>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 CSM x 15.00 = SUBTOTAL $ ,- 9`° PLUS: PROCESSING FEE + $ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT .__s,/ FEE DUE = $ � SIGNATU E�� �L J Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675