1992, 09-11 Permit App: 92007484 Water Heater •
35 ac\3" 0'659 t -1 MECHANICAL PERMIT APPLICATION FORM a"
I-- � 1
Inforrr,ationgorksheet 3
JOB STREET ADDRESS: S 4 l S E // , A tk.'
CITY/STATE/ZIP: -Ca.vi P 4 9�z/1 PARCEL NUMBER:
OWNER: k_5193/4g /4 S'17f4HH' PHONE NUMBER: 6'31-7 8 3?
MAILING ADDRESS: _Sgyp1r A _aC.
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
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 x 10.00 =
...§1:igp,1::f;:.;:.;:::; ;: M. 00 'tJ{INCL0bg: ......... .........: x 12.00
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
x 1.00 =...
BOILER/REFRIG 1-100M BTU x 12.00 =
:.;;C ;.;:.>::;: .;;:.: e 1,.01:11111;5 1M,;8'rU;::>::>::;::;:.;:.;:.;:<;<:::::>:.;.:.:.:.;:.;:.:;.::.;:;.;;;:.;;::.;:.;::. x 20.00
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BO::,<.E,;.:lt01_.I;.,.;I;0;.0 : ::<_6:61:;.:.::.T .'<'><<<;» >< >>'<> y'<><«< =
Oi4Ei�REEt�1� ����q1 'f,75QM 1�7'C1: x 35.00
BOILER/REFRIG +1,750M BTU x 60.00 =
: .;:NDITION ER:. =
. . T [1 >>>< x 12.00
HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 =
HEA >� '::.:,::: :.reat::,..:;.,..:IONewisg:0,.::..:; ::'.;mi iii mini =
':# MP:. ;AidA11 (TtNl .;75f ;7;01 .;:,:,:,:.;;:;.;::.;:.;:.; x 25.00
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
H,...:.::.:: 'U;:.;:. Alft MorrI N ER+50 TO 4 ........;»::::::>:;:::::>:::: 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 =
x 10.00 =
::::::::.:.:G�........ ......... ...:..... .... ..... ........ . ......... ......... .......
GAS LOG x 10.00 =
MISCELLA U' . N `'> VERED.BLSEWHEI E `<<> «<< x 1 =
......... .;;:.;:.;N� �S;:�.:;.;:�.;;;CO:.;:.;;:.;:.:;.;:�;;:.;:.;:;;;:.;:.;;;;:.;:.::.;;:.;;;;:.;:.;:.;:.;:.;:.;;:.;;:.;;:.;:.: 0.00
............ .
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
x100.00-
=
AIR HANDLER<10,000 CFM x 12.00 =
x 15.00 =
SUBTOTAL $
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
\ FEE DUE =$
SIGNATURE `Ao ia„,,(.P $La&
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675