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1991, 04-22 Permit App: 91001753 Water Heater MECHANICAL PERMIT APPLICATION FORM Information Worksheet v /Fr/ WATbSot) JOB STREET ADDRESS•: _ •> i,��II1'tLL COAL v, CITY/STATE/ZIP: Ia /4 AAA/ 1 WA- q9(9a PARCEL NUMBER: OWNER: Af (LAY/11, , tech-i✓1.c9-t!t£.Gh. PHONE NUMBER: 37,3(1-(WO MAILING ADDRESS: )4 / 70-(9 gcou.„,•ti. p0, &paleaite , W& • q°0/�- Street} (City/Statile) < (Zip) CONTRACTOR: jcia.A,4_,) OR 1/ I ; ‘ - LICENSE NUMBER: 'A/� - 61 - 37:/t7 PHONE NUMBER: qs9- //70 V 30-1 / MAILING ADDRESS: P9 6 3'70'7 vf te)a_ 9 l c /�- (Street) (City/State) (Zip) J. 1. p_ ! 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 . 00 HEATING EQUIPMENT <100, 000 BTU x 12 . 00 = HEATING EQUIPMENT +100, 000 BTU x 15. = GAS PIPING (1 - 4 OUTLETS) x GAS PI?ING (5 OR MORE. EACH: ) x 1. 00 = 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 1 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 $ (0 C.r 0 )4:k34/43S- PLUS : PROCESSING FEE-+ $ 25 . 00 EQUALS: TOTAL PERMIT oo NOTE: INI�MUM�P I -FEE ISS 7.00 FEE DUE = $ 3s-SIGNATURE thhaL, .• /il-(.L Spokane Coun'��' epartment of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675