1990, 03-26 Permit App: 90001073 Water HeaterMECHANICAL. PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: 6• 4014x q�j drd-j-
CITY/STATE/ZIP: / LtJA /-1249 PARCEL NUMBER:
OWNER: I qq������� ,, /�
MAILING ADDRESS: . 240/1-1-utrd a
0,816 or (}Zi.lo 44kioe-r
CONTRACTOR:
PHONE NUMBER: 9.2-0 - 11679
(Street)
MAILING ADDRESS: E. L//ott Ralf,
(Street)
IgLI Ie/ (OP c82 -da
(City/State) (Zip)
LICENSE NUMBER: R. i PLE Pii O%8J0
PHONE NUMBER: 525-)919 orS%r4 j
, 10/1 Cri2o2.
l(City/State) (Zip)
MECHANICAL
DESCRIPTION
WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
= AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PIING (5 OR MORE. EACH:)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDITIONER 0-3 TONS
AIR CONDITIONER 3-15 TONS
AIR CONDITIONER 15-30 TONS
AIR CONDITIONER 30-50 TONS
AIR CONDITIONER +50 TONS
FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12'
TYPE II HOOD
OR 12' PTN. OF HOOD)
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)
UNLISTED GAS APPLIANCE <400,000 BTU
UNLISTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 4.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
NOTE:
SIGNATURE
MINIMUM PERMIT FEE IS $35.00
SUBTOTAL
$ IO.co
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 35.0c,
pokane'Couh#y Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675