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1992, 12-04 Permit App: 92010663 Water Heater, Piping SZ MECHANICAL PERMIT APPLICATION FORM 6 m Inforation Worksheet (A aW�) 1 JOB STREET ADDRESS: / (9 / b L ` 4 tO fa r ' `) l'A (0C\101 CITY/STATE/ZIP: 1 La PARCEL NUMBER: OWNER: L,T PHONE NUMBER: .�v` '61) 6,2-, MAILING ADDRESS: 0?l 'C - (Street) (City/State) (Zip) CONTRACTOR: PECK PLUMBING & HEATING LICENSE NUMBER: PECK#177DC t Eqf-i)k t ar PHONE NUMBER: 328-4325 MAILING ADDRESS: 2708 NORTH RUBY STREET SPOKA, WA. 99207 (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 / x 10. 00 = /0 ,6e HEATING EQUIPMENT <100, 000 BTU x 12 . 00 = HEATING EQUIPMENT +100, 000 BTU x 15. 00 = GAS PIPING (EA OUTLET) I x 1. 00 = J r 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 T_ HOOD (PER 12 ' OR 12 ' PTN. OF HOOD) x 50. 00 = x 10. 00 = TYPE II HOOD x 10. 00 = CLOTHES DRYER x 10. 00 = RANGE x 10. 00 = GAS LOG MISCELLANEOUS (NOT COVERED ELSEWHERE) x 10. 00 =_ 50. 00 = UNLISTED GAS APPLIANCE <400, 000 BTU x_ _ x10. 00 = UNLISTED GAS APPLIANCE >400, 000 BTU_ _ 50 . 00 = USED APPLIANCE <400, 000 BTU x x1 0. 00 = USED APPLIANCE >400, 000 BTU x 12 . 00 = AIR HANDLER <10, 000 CFM x 15. 00 = AIR HANDLER >10, 000 CFM SUBTOTAL $ ,i(.0-')- #. f(•S-')- #. PLUS: PROCESSING FEE + $ 25. 00 EQUALS : TOTAL PERMIT Mij, .+- IS $35. 00 FEE DUE = $ a°S(� �� NOTE � ��,,��.sys ' SIGNATURE �/. , ��/Ltpimp::� z7,------ Spokane Bro ayDepartment Spokane,WAS 99260 Safety 09) 456-3675 West 1303 Broadway County_