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1991, 07-22 Permit App: 91004360 Water Heater, Piping MECHANICAL PERMIT APPLICATION FORM br Informatio Worksheet JOB STREET ADDRESS: 4 o_ )2A,41 AL, 0/ kbc CITY/STATE/ZIP: / W 4 Z M/e4RCEL NUMBER: OWNER: ri4A.ALO C5)-7( PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: LICENSE NUMBER: AA/ft/A-AC-79,W/ PHONE NUMBER: l _ g/00 m. MAILING ADDRESS: (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 C Y x 10.00 = (Q,Qe HEATING EQUIPMENT <100,000 BTU _ _ _ _ _ x 12.00 = HEATING EQUIPMENT +100,000 BTU _ _ _ _ x 15.00 GAS PIPING (EA OUTLET) ( x 1.00 = leo?) 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 $ / l , ©a PLUS: PROCESSING FEE + $ 25. 00 ^ EQUALS: TOTAL PERMIT NOTE: NI 7ARMIT IS $35.00 FEE DUE = $ 3 (0. 00 SIGNATURE ,Q Spokane County Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675