1992, 03-04 Permit App: 92001241 Heater, Piping MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRES : � o4
CITY/STATE/ZIP: f Co 4,9 i•JC I4.)a , PARCEL NUMBER:
OWNER: 00 In t°115 PHONE NUMBER:
MAILING ADDRESS: Sd'l r-' C
(Street) (City/State) (Zip)
CONTRACTOR: /0 rvl e(r,61 ^C' I C c G„od fc. LICENSE NUMBER: (Pi'v2 pP e4, 10 I L- l4
PHONE NUMBER: .c 3`-1 )LI O0
MAILING ADDRESS: J O C s"'7/5 5 1 dam' S ,o/O4/0( ?9x,20
(Street) (City/tate) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
x25.00 =
GAS WATER HEATER x 10.00 =
OAS EQ1311?MI=NT �QOaOt�►��'U�1NCL�UI=S » ''°'`:� �. x 12.00 = / ,
e
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
x 1.00 =
BOILER/REFRIG 1-100M BTU x 12.00 =
x 0
2 00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
x35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
....
HEAT PUMP&AICA CO0:
NDITIONER TON$ ><`` x 12.00 =
HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 =
HEATOMP:.&.AtRONM't'INER5'':04.::D::::S::.. .:..:::::::
x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
HEA `PUMP " °.:AIR + NDITIONEI +5 TONS ::::>: 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 0
1 00 =
TYPE 11 I�OO ...........::.;:::.;:.;:.;:...... ... .
CLOTHES DRYER x 10.00 =
x 10.00 =
:;::;::.:::..:::... .
GAS LOG x 10.00 =
MI C LLANEOC S(NOT COVERED ELSEWHERE; `:''''' ° x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTED SAS APPLIAN 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 _ $
SIGNAT
Spoka a County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675