1992, 06-09 Permit App: 92004135 Water Heatert)1/4.) at,umn4A)1 �1�, MECHANICAISP�F MffcAPPLICATIONFORM e
L lr�1PS co o� tint ormaUon:WorJCsheet• �op!lill3
JOBSTREETADDRESS: t roc) I )' 9,..1--V'•k `b11j
CITY/STATE/ZIP: SpA it1R— tn1ir.'4Cai . PARCELNUMBER:
OWNER: _ --dl. Mc- Q nY',x, c 4-1RtiONE NUMBER' So`/' 518' )5W/ 1
MAILING ADDRESS: CA tri -C.: ra . •it,
(Street) ,Sn�,'x, (City/State)
CONTRACTOR: Ripley's -Plumbing;Pc. LICENSE NUMBER: RIPLEP1107B6
.r.�+..,t7 .t .,, PHONE NUMBER. 509-535-1919
(Zp)
MAILING ADDRESS: 4104
E Pratt ^_ ,t Spokane, WA
99202
(Street);,4 (City/State)
MECHANIC AL,WOI KSHEEf/FEE SCHEDULE
' .1I3IBER,
DESCRIPTIONha'r�; "` OF UNITS
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS
10500sT aa
GAS WATER HEATER
gear. 4.°)re d!i.° mosi
GAS EQUIPMENT+100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1 000M.BTU
BOILER/REFRIG'+1,750M BTU
HEAT PUMP & AIR CONDITIONER 3-15.TONSi;_
¢l6AT Iliadn-70 R> O "EH S
HEAT PUMP & AIR CONDITIONER 30 5OffON
X EACH
UNIT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x15.00=
x 1.00
x12.00
''x -20.00,==j
X25.00,4.44
4-1E?T P
VENTILATING
TYPE 11100D (PER 12' OR 12'
PTN5OF HOOD
CLOTHES
GAS LOG'
nlaikTUV
DRYER
UNLIS 1 tU GAS APPLIANCE <400;000 BTU
USED APPUANCE.<400,000
AIR HANDLER <10,000 CFM
NOTE MINIMUM PERMIT FEE IS $35A0',
SIGNATURE
aC,
a 4i
Non�gnty Divisign of Buildings
West 1303 Broadtw %X nue.3pokane, WA 99260 (509) 456-3675
x3500'
x
eo.00Q?
= AMOUNT
X 12.00'„=
x 20 00 ai
x25.00 r:..
x35.00'=
x 60.00 _''
10.06-1
x10.00
(50.00 =
x10.00
x 10.00
x 10.00 =
x10.00 =
x 10.00
x 50.00 =
x100.00 =
x50.00=.
x100.00
.x:12.00is
x 15.00 =
SUBTOTAL
PLUS: PROCESSING FEE
EQUALS: TOTAL PERMIT
FEE DUE
$ tOoo
+$ 25.00
=$ -SOo