1993, 06-25 Permit App: 93005128 Water Heater, Piping`� 31AECHANICAL PERMIT APPLICATION FORM
. f -i 5 46 au - Information Worksheet
JOB STREET -Apo' KESS: 6 (le e a)
CITY/STATE/ZIP* 0,l mu W q92/., PA'CEL NU BER:
OWNER: O� ?IIII LE' i & 11) i S PHONE NUMBER: 907 - 1/2•7
MAILING ADDRESS*
(Street) (City/State) (Zip)�r
CONTRACTOR: A) • l[ % • e &r/ Ni & pl Pe LICENSE NUMBER: f w a C ! Ca T'7
PHONE NUMBER:
MAILING ADDRESS* -P • ON 0 (- l 54 9 �V } IJ i /� 9 %,v3
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
W000STQVI~IINSERT
GAS WATER HEATER
.0.. EQuiPMENF QQ A00:ETU IN. I IQES :...::
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
IIEAT PUMP: ►IA',CONDITION
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PtlMP; ,I:IR CpNQ) 'IONEl 1 w 4 TOMS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
fki ►T:PUMP {AIR O DITIONER:t50 TONS :,...:.
VENTILATING FANS
TYPE 1 HOOD (PER 12' OR 12' PTN. OF HOOD)
ingisiboimva
CLOTHES DRYER
........ : :>..•.o:7A:xo:£3cL'k:JVo•�'.,}:.:.�'.. `'F ........'iS�f'2
GAS LOG
UNLISTED GAS APPUANCE <400,000 BTU
USED APPLIANCE <4IPPI<.00,000 BTU
AIR HANDLER <10,000.64'
NOTE MINIMUM PERMIT FEE IS $35.00
SIGNATURE • '!' r ` /"T
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
/
x 10.00 =
/ d .0
x 12.00 =
x 15.00 =
_ ...
%• n0
/
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x60.00 =
x 12.00 =
x 20.00 =
x25.00 =
x 35.00 -
x60.00 =
x 10.00 =
x10.00 =
x50.00 =
x10.00 =
x 10.00 =
x10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 -
x 12.00 =
x 15.00 =
SUBTOTAL
$ / /. 07)
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_$ ��Ce6'-6
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675