1993, 02-04 Permit App: 93000616 Water Heater, Piping ' MECHANICAL PCRMIT APPLICATION FORM -- ('
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Information Worksheet . 0�
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JOB STREET ADDRESS: . L �� /C M -�._
CITY/STAT IP:N5 () . o 92 / e/ PARCEL NUMBER:
OWNER: `1r` lel IL PHONE NUMBER:_ -6-3(1-.3n
MAILING ADDRESS: -,
(Street) (City/State) (Zip)
CONTRACTOR: r3ca en C(f(1114 LICENSE NUMBER: /CC( -{jA/�(12Z-
PH E NUMBER: ,..5 (•-( ((q2
MAILING ADDRESS: C. 5l L�� -77u/r � L). %A /zi z
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
WOODSTOVE/INSERT.....: ::. x 25.00 =
GAS WATER HEATER t x 10.00 = M. db
GAS EQUIPMENT<1Q0,000 UTU,(INCLUDES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING (EA OUTLET) :. ... . , x 1.00 = /;c 7)
BOILER/REFRIG 1-100M BTU x 12.00
BOILEFV:REFRIG 101500M BTU >' x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
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BOILER/REFRIG 11,0001-1•••••••-•-•50M IBTU x 35.00 =
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 CONDITIONER 15--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 Ix 10,00 =
EVAPORATIVE COOLERS _1 ., 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) _ x 50.00 =
TYPE IIHOOD - - �- x 103.00 = •
_
CLOTHES DRYER x 10.00 =
RANGE `, • x 10.00 =
GAS LOG x 10.00 =
MISCELLANEOUS (NOT COVERED ELSEW1-IEF1C :: x1,0.00 =
UNLISTED GAS APPLIANCE <400,000 BTU x 50.'001 = -__,
ULINSTED GAS APPLIANCE>400,000 13TU x100.00 =
USED APPLIANCE<400,000 BTU x 50.00 = _-
USED APPLIANCE>400,000 BTU x100.00 = r
AIR HANDLER <10,000 CFM _ x 12.00 =
AIR HANDLER>10,000 CFM x 15.00 =
SUBTOTAL $ /i, (rb
PLUS: PROCESSING FEE + $ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT FEE
FEE DUE = $ , a
e SIGNATURE_ ,,.y-- / ' -//.
Spokane County Division of Buildings
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