1994, 07-08 Permit App 94006327 Wtr HtrMECHANICAL PERMIT APPLICATION FORM
Inform,h Worksheet
JOB STREET ADDRESS: 'I--
CITY/STATE/ZIP: ”,4010 PARCEL NUMBER:
OWNER: PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: )
LICENSE NUMBER:10e, ?4i
/ /
PHONE NUMBER: 5- 7_)7--jii?
(Q32-7
MAILING ADDRESS: _5* _? , rQ_
(Street) (Cify/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
. . .........
wpory67,Q.VqMg.M ga
GAS WATER HEATER
::GAS.::(;10)PMENT:i0.00;00.0$T.07(I.00(3mE
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIGi;OXii41756M 'BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEATPOMP::&:*04::cdootrioNER.1.54107TO
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT
VENTILATING FANS
EV4PcMATP;ItCQOLERS•
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPEIIHOOD
CLOTHES DRYER
RAIGE
• .
GAS LOG
MSCELLANEbUS(Ncr COVERED ELSEV'H ERE
UNLISTED GAS APPLIANCE <400,000 BTU
IJLINSTED.GAS:AppLIANCE*00.;000 BTU
USED APPLIANCE <400,000 BTU
USEaAPPLIANCE'*00..;000.BIU •
AIR HANDLER <10,000 CFM
'AIR'
NOTE: MINIMUM PERMIT FEE IS $35.00
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00 mg
/
x 10.00
x 12.00 =
x 15.00 =
x too =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 1.0.00 =
x ROO =
x100.00 =
x50.00 =
x100.00 =
x 12.00 =
• 4
•
x 15.00 =
SUBTOTAL
$ /0. 0
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=S3b.011.)
SIGNATURE
Spokane County Division of Buildings
West 13i °way Avenue Spokane, WA 99260 (509) 456-3675