1992, 10-02 Permit App: 92008354 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
7\ %35`�
Infoynation Worksheetj�
JOB STREET ADDRESS: 1 5 0.9 / E. C -T (4+t 1p i c
CITY/STATE/ZIP: �,�o j11 f ��1 j" 1 kQ ( t� PARCEL NUMBER:
OWNER: R;0K ciA-i1'/Vc11l/ PHONE NUMBER:
Ou v -c I yck `lam
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: Heat Transfer Inc. LICENSE NUMBER: Heatti-1881n
PHONE NUMBER: 328-3400
MAILING ADDRESS: N. 1008 Ruby Spokane, WA 99202
DESCRIPTION
(Street)
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER
GASBEQUIPMENT;<10O;000_BTU,(1NCCUDES.t._,.
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET). - -
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REF9jel 01)0E-us0M
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT. P U M P: & AIR CONDITIONER 45-30. TONS:
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP &:AIR. CONDITIONER +50 TONS
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
MISCELLANEOUS (NOTGOVERED ELSEWHER
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED: GA$.'APPRIANCE.>400,000BTU ,.:: ;:; ;`::
USED APPUANCE <400,000 BTU
USED APPUANCE>400.000 BTiisS =:'
AIR HANDLER <10,000 CFM
AIR:HANDLER>10,000'CFM _:',.:
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
R
(zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
I
/t9.C) 6
i
x12.00 =
a,.f)f
x 15.00 =
2
x 1.00 =
07.00
x 12.00 =
x20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x12.00 =
x 20.00 =
x25.00 =
x 35.00 =
x60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
/a, On
x 10.00 =
x 50.00 =
x100.00 =
x50.00=.
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$ ,9 ki 60
G1Ed' USING FEE
+ $ 25.00
zip
EQUiFP44' `FEEDUEAL MIT
=$ 6/.O1()
BUILLAM2 & SAFETY
Spokane Qlunty Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675