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1992, 07-14 Permit App: 92005271 Heat PumpL\SOR\.Dlao :' Ga S�`i� 0, 1101-11 ��e ti 3(.05 MI i'�� b,3MECHANICAL PERtvi1TAPPLICATION FORM . Information Worksheet •.. ' JOB STREET ADDRESS' •''f 11623 E. Fredricks ; ; •v;`- f.. CITY/STATE/ZIP' -SS Wa 99206 . PARCEL.NUMBER: ' " " .*:'• • > _ PHONE NUMBER: '(509) 927-1095 OWNER: 11623 E. Fredricks MAILING ADDRESS: (Street) CONTRACTOR: Sturm Heating, Inc. MAILING ADDRESS' E. 204 Indiana (City/State) LICENSENUMBER: STURMI* 210 QF PHONE NUMBER: 325-4505 Spokane WA. 99207 (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYS I tMS) GdS O S> Fa GAS WATER HEATER GAS EQU IPMENT +100.000 BTU DUCTWORK) •Gt+StPtPtNGi • QUT,t..:?A,+„ ;s.f. n-,`:44 mgmtk?...e BOILS R131 EFRIG 1-100M BTU t 1RgR1REFEi( 1.0- e e . BOILERIREFRIG 501-1,000M 8TU . ..: - 001 .. 327•5OMaB sLs r;r BOILERIREFRIG+1,750M BTU ' • ER,O- O"NSA HEAT PUMP &AIR CONDITIONER 3-15 TONS i E ipa =BAffitCONQUR ERm1'6r3O 0 HEAT PUMP &AIR CONDmOw NER 30-50 TOTS' kES 4SMP$ t' ©NDITI,ONER+50 S ° VENTILATING FANS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) 7YPP�i�(iHOO© �:al .r4 v CLOTHES DRYER. - GAS LOG O E COVEREDiELSEW UNUSIEU GAS APPLIANCE <400,000 BTU USED APPUANCE<400.000 BTU .5ED7APiWiVO>4900010,C13Th:.;;;..:^.r=:>94 AIR HANOLER<10.000_CFM ' 1R1tfATl 6000'9I6FM" _�.CrItt.c'_=''at"<;' NOTE MINIMUM PERMIT FEE IS $35.00 SIGt1ATURE_, Rip) NUMBER OF UNITS X EACH UNIT =AMOUNT x 10.00 = x 25.00 = x 10.00 = x12.00 = x 15.00 = x1.00 = x12.00 =. . -- x 20.00 = •- x 25.00 ,_ A. x 35.00 =' x 60.00 = "• x12.00= x 20.00 = x25.00 = x 35.00 = x60.00 = x 10.00 = ' 12 00 ' x10.00 = x 50.00 = x 10.00 = X 10.00 = x 10.00 = x 10.00 = z 10.00 ="•' x 50.00 = x100.00 = x 50.00 = . x100.00 = • x12.00 = x 15.00 = . - SUBTOTAL $12.00 PLUS: PROCESSING FEE I +$ 25.00' EQUALS: TOTAL PERMIT FEE DUE = $37.00