1993, 01-05 Permit App: 93000020 Water Heater, Piping MECHANICAL PERMIT APPLICATION FORM ziy y�
Information Worksheet
JOB STREET ADDRESS: /f5 /' p 1f1 IL&., LAc -2079'
CITY/STATE/ZIP: i&f�a� , L611 PARCEL N BER:
OWNER: z 4 dC)01 114 *I INtSW PHONE NUMBER: PECKQN. / 22-De
MAILING ADDRESS: 5-..3,5/& vet P.i� ���' i ' 8 -, q -y
(Street) (City/State) (Zip)
CONTRACTOR: PECK PLUMBING & HEATING LICENSE NUMBER: PECK#122DC
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 7. x 10.00 = 11 PO
HEATING EQUIPMENT <100, 000 BTU x 12. 00 =
HEATING EQUIPMENT +100, 000 BTU x 15. 00 =
GAS PIPING (EA OUTLET) r. x 1. 00 = / r%f)
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 = i.
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 $ n191)
g1)
'; PLUS: PROCESSING FEE + $ 25.00
EQUALS : TOTAL PERMIT �
NOTE: MI •E• ,. rte F - $35. 00 FEE DUE = $ di'N rt
SIGNATURE/ 407���
Spokane County Department of Building and Safety
West 1303 Broadway p Avenue Spokane, WA 99260 (509) 456-3675