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1992, 03-27 Permit App: 92001936 Heat PumpJOB STREET ADDRESS: CITY/STATE/ZIP: OWNER: % HCC A) MECHANICAL PERMIT APPLICATION FORM Information Worksheet E /.3.70/ .8/0J367 PARCEL NUMBER: co me- 6_,/ MAILING ADDRESS: PHONE NUMBER: -E /330/ .acos-r.Ey (Street) (City/State) CONTRACTOR: /'�NNC'2- FGc,Or4c Ft flemSc10ENSE NUMBER: eA/'i^i oc6F 37J#' y PHONE NUMBER: ala- (36 /aS 92Yt-/7y7 (Zip) MAILING ADDRESS: DESCRIPTION ►� 0 3 ene 41.3 yrP . SPotit / 0-'41 (Street) (City/State), MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) ................... WOODSTOVE/INSERTs<_ 'rs <<:;::;? >:; ?;•<:; GAS WATER HEATER :GAS, EQUIPMENT:?00,00aftr(INCLIJDES' GAS EQUIPMENT+100,000 BTU DUCTWORK) 'GAS PIPING'(EA_OUTLET) ...' BOILER/REFRIG 1-100M BTU BO(LEIiiREFHIG 101x.4737 BOILER/RE:FRIG 501-1,000M BTU 'BOILER/REFRIG 1,;000T-1,750M°BTU._` BOILER/REFRIG +1,750M BTU HEAT PUMP'»IR _CONDITIONEq 0 3;T5 HEAT PUMP & AIR CONDITIONER 3-15 TONS [1:1.4ATT.P.MWMCgati.01:4:4014,41401r HEAT PUMP & AIR CONDITIONER.3050 TONS HEAT PUMPIIi tOND FLOVI.?:+50 TQ IS.: 4 VENTILATING FANS EVAPORATIVECWl1=Rg,76: TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPE1(HOODr i : ; CLOTHES DRYER GAS LOG MISCELLANEOUS (NOT COVERED ELSEWHERE UNLISTED GAS APPLIANCE <400,000 BTU ULINSTEO„GAS:APPI IANCE_>400;0Ut1 gTUx <F . USED APPUANCE <400,000 BTU ;USED_APPLIANCE3400;OW- :OW -- AIR HANDLER <10,000 CFM AIR HANDLER.910;000 CFMx NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE 9 y2o L_ (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x10.00 = x 12.00 = x 15.00 = x1.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x12.00 = x20.00 = x25.00=. x 35.00 '_ x60.00= x 10.00 = x 10.00 = x 50.00 = x10.00 = x 10.00 = x10.00 = x 10.00 = x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x15.00 = • - / 2o.os. SUBTOTAL $ z,,,,,, PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE _ $ s%j °' Spokane County Division of Buildings West 1303 Broadway Avenue Spokane; WA 99260 (509) 456-3675