1992, 10-30 Permit App: 92009559 Water Heater, Piping � C /)' 9(2 r 17(
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADD' SS: /7/ 6/ E ///i._
CITY/STATE/ P CL! C i 6 PARCEL NUMBER:
OWNER: 4.2 )'? PHONE NUMBER:1,CC��
6 -//, ()
MAILING ADDRESS:
(Street) (City/State) (ZIP)
CONTRACTOR/)r Co7RC2 �-7 LICENSE NUMBER:A,t2t?Di}117(��Z�
PHONENUMBER:�3�1( 25-
MAILING ADDRESS: �� � 7��� 4z). / 99,7/Z�
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
WOOt7STOVEIINS RT .. .....:.. . . .. x 25.00 =
GAS WATER HEATER it x 10.00 = //),
GAS EQUIPMENT«00,000 BTU{INCLUDES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING (EA OUTS x 1.00 = / GQ)
BOILER/REFRIG 1-100M BTU x 12.00 =
BQILERIREI=RIG 101 500M BTU x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
t3QILEWp PI fG 1$0001 1,7SOM;> TU x35.00 =
BOILER/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 CONDITI;ONER;;15 30 TONS x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
HAAT PUMP &AIR C ?NDITION R'+50 TANS ;'> x 60.00 =
VENTILATING FANS x 10.00 =
VAPORATIVE COOLERS x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
TY:PE II;HQQD< x 10.00 =
CLOTHES DRYER x 10.00 =
RANGE ' x10.00 =
GAS LOG x 10.00 =
MISCEL ANEOUS (NOT COVERED ELS WHE x 1000 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTED 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 GFM x 15.00 =
SUBTOTAL $ Orb
PLUS: PROCESSING FEE + $ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE = $ 73( G�
SIGNATURE �� t /2/ 1-ef-,
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675