1993, 08-04 Permit App: 93006514 Water Heater, Piping q3 " ( !
MECHANICAL PERMITAPPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: /0 YO 3 ` '/62
CITY/STATE ZIPS-- DAi2 ee-/ LE /4J PA6EL NUMBER:
OWNER: jP A ADA/2. 6=-:- / PHONE NUMBER: 9c,2 /._ c7' 6
MAILING ADDRESS: 5A1
(Street) (City/State) (Zip)
CONTRACTOR: /)• L• / Q 177/116 /2//'E LICENSE NUMBER: No 4,77-64 A d
PHONE NUMBER: 9c,7,) - 1/4Y9
MAILING ADDRESS: -PC • ,d/( /3 </ /9 ?3z'/((NP, (L)/9. 1.3
(Street) ) (Zip)/State(Cit Zi -
( Y
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
I IQQOSTQYE/INS i T ':»>> x 25.00 =
GAS WATER HEATER / x 10.00 = /0•60
GAS E.QA.N. 1)0.0.0 O BTU::(INCLUDES ....::. x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00
-----------
x 1.00 = /, DO
BOILER/REFRIG 1-100M BTU x 12.00 =
x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BQJLF IEMFFNIQQQT. 1 750M.. TU.., Iw. ::...... x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
NEAT PUMP . IR QONI�ITION R 0- TON x 12.00 =
HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 =
kiEAT.PUMP;A AIR CONDITIONER;043q'TQNsimigigaigi x 25.00 =
HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 •
HEAT'PUMP&AIF CO IDITIONER#50 TONS x 60.00 =
VENTILATING FANS x 10.00 =
EVAPtA' YQC7 .fR :...... x 10.00 =
TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD) x 50.00 =
x10.00 =:::::,:::::.:.,.::::::.:;;
CLOTHES DRYER x 10.00 =
x 10.00 =
GAS LOG x 10.00 =
ISCELI ANEOUS.(NOT COV REt El.S 1WH RE x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
lf,INSTEt GAIL RP .IANC 4001000 BTU
x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
$ED APPLI CE
t ,000::0Ty.:::.:: .:.:... x100.00=
AIR HANDLER<10,000 CFM x 12.00 =
AIS:HANDLEF lO.QAQ.CFM:... x 15.00 =
SUBTOTAL $ //DO
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$ 06.0
SIGNATURE Q. ."
/026 Spokane County Division of Buildings
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