1991, 11-30 Permit App: 91008571 Mechanical Fixtures 35as H
t I �, e v MECHANICAL PERMIT PPLICATION FORM q l - 5-it.-
w . tt "G 6 Information Worresheet
JOB STREET ADDRESS: /47'.?0 k -
CITY/STATEIZIP:S;12I'*<-5t/7./ - l��_ 'F'?.. /(..�
PARCEL NUMBER:
OWNER: ' 17,v, /�„9 .,-i PHONE NUMBER: '. - -'-Z,2 C(**
�
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
(Street) - (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
WOODSTOVE/INSERT x 25.00 =
GAS WATER HEATER / x 10.00 = /%1' "--'
GAS EQUIPMENT. . ... 0BTU...INCLUDES` } `..f ; / x 12.00 = /2 (;. -
GAS
" -
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING (EA OUTLET) x 1.00 -'
BOILER/REFRIG 1-100M BTU x 12.00 =
BOILER/REFRIG 101 SOON BTU,' <$>'._ ::< x 20.00 =
BOILER/REFRIG 501-1,000M BTU . , x 25.00 =
BOILER/REERIG 1,0001 1:.750M'BTU x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP& AIR'CONDITIONER 0 3:TONS? x 12.00 =
HEAT PUMP & AIR CONDITIONER 3-15 TONS x 20.00 =
HEAT PUMP &AIR CONDITIONER 15 30 TONS x 25.00 =
HEAT PUMP & AIR CONDITIONER 30-50 TONS x 35.00 =
HEAT PUMP & / !R CONDITIONER +50,TONS x 60.00 =
VENTILATING F;\NS x 10.00 =
EVAPORATIVE COOLERS x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
_TYPE II HOOD ...
: , x10.00 =
CLOTHES DRYER x 10.00 =
RANGE , ,,
x10.00 =
GAS LOG x 10.00 =
MISCELLANEOUS'(NOTCOVERED ELSEWHERE ''- x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU • x 50.00 =
... .......... ...................... ............................................. .....................................................
ULINSTED GAS APPLIANCE>4.00,00U:,ETU: .... x100.00 =
USED APPLIANCE<400,000 BTU x 50.00 =
.USED APPLIANCE_+400,000 t37t1 x100.00 =
AIR HANDLER<10,000 CFM x 12.00 =
LAIR HANDLER>10 000 CFM f
f x 15.00 =
-
SUBTOTAL $ Ott'G-'.-
•
PLUS: PROCESSING FEE + $ 25.00
NOTE: MINIMUM PERMIT FEE IS $35.00 EQUALS: TOTAL PERMIT
FEE DUE = $
SIGNATURE ✓rF,. .K` _ ,...."-1.110
I* a% Iiiibl
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 3 r
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