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1991, 04-23 Permit App: 91002025 Water Heater MECHANICAL PERMIT APPLICATION FORM - Information Worksheet JOB STREET CITY/STATE/ZIP: _,00 < / G�/d 5'9,2dG, PARCEL NUMBER: OWNER: /71-6 7 , /f��a`i r-, t-7,-1-7-7e)PHONE NUMBER: MAILING ADDRESS: (Street) (City/State)�4 �(Zip) 1 CONTRACTOR: , / , s¢iz/ � �A �--1<Y LICENSE NUMBER: k PHONE NUMBER: ?? 3 '32r MAILING ADDRESS: //32 3 W, - , ,,, S S 2 (Street) (City/State) gip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = x 25.00 = GAS WATER HEATER /r��,�s'i-c x10.00 = ::.::-::::. igiN ..:::O..::::: .000:sh .. soutogS.` :<: < = >>`n x 12.00 = GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 :GAS PIPING(EA OUTLET x 1.00 = BOILER/REFRIG 1-100M BTU x 12.00 = NQ1.lEId:-X4R..(3.........V.::---::::.;--<::: MEININ - x 20.00 = BOILER/REFRIG 501-1,000M BTU x 25.00 = - IratREFRIG_'1{=0001...1,750M BTC) . :.. ..:::.:;.:::;..: '..::`: x 35.00 = BOILER/REFRIG +1,750M BTU x 60.00 = HEAT PUMP&AIE CONDITIONER 0. 3 TONS "-.n:: :: x 12.00 = HEAT PUMP 8,AIR CONDITIONER 3-15 TONS x 20.00 = HEAT PUMP&AIR CONDITIONER 1 S;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 = x-10.00 = TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD) x 50.00 = x 10.00 = CLOTHES DRYER x 10.00 = fFa :Ca: :..::..__._ x 10.00 = GAS LOG x 10.00 = ti4__ ; €f.1 „1001 +4V I f Y1 J$£iN00RE ";fit x 10.00 = UNLISTED GAS APPUANCE<400,000 BTU x 50.00 .. .......:. • LlNS` !GiAS A, A C 40Q t 0 BTCr » :<::>:::>;:: x100.00 .%:.:•::fin\vvvAMr..vv.vxfrI XnI �. ::: _ USED APPUANCE<400,000 BTU x 50.00 = . �'..- 71777:44-0::f8+8 �M- t.'d� xt:;r.:::::?i.'f^i;:-:»r-:::,...---,�....:::y-.y- 00 ..io::�}.,,.:..a-x•.,.•,::.�::kw� s:':..':-� .: :;�£'.v�!;r:;n,•M1{%;::,:s AIR HANDLER<10,000 CFM _x 12.00 = WITH♦♦v�-xny:r: wn^^yO1C�i-:�1�.7/v:j/^�.�4}:•W^:,:�,.1:-.v...:y:.v`:::{:i?x i?. .wi}i..�}i::�-v}_.i�::,vj¢w};:vihx;.:i _-Yi::�:: _ _ ......:.. .. ............ x 1500 SUBTOTAL $ PLUS: PROCESSING FEE • +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS:TOTAL PERMIT FEE DUE _$ SIGNATURE Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675