1992, 09-04 Permit App: 92007185 Mechanical Fixtures(A\\ t`kC`\
MECHANICAL PERMIT APPLICATION FORM
rtlntor nation Worksheet
Larch '�
99216 PARCEL NUMBER:
JOB STREET ADDRESS: 4507 N.
CITY/STATE/ZIP:Spokane, WA
OWNER: Roger Rife
MAILING ADDRESS:
o,a-i135
1 Jo(0Z,
PHONE NUMBER: 928 0584
(Street)
CONTRACTOR: Inland Heating
MAILING ADDRESS:
3655 Govt. Way
(Street)
MECHANICAL
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER
GAS'EQUIPMENT, <100,000. BTU (INCLUDES
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS PIPING EA`„OUTLETj::: ,':''.;
BOILER/REFRIG I-100M'BTU
(City/State) SUNLOI107J6
LICENSE NUMBER: SUNLOI1O1JB
PHONE NUMBER: 455-4147
Coeur d'Alene, ID 83814
(City/State) (Zip)
WORKSHEET/FEE SCHEDULE
NUMBER
OF UNITS
(Zip)
X EACH
UNIT
= AMOUNT
E101(*111003170114001:010..
11; 00M18TU>'
BOILER/REFRIG 501-1,000M BTU
:ROILEHIREFJ IGi,000Tf41i,750M:BTU:::
BOILER/REFRIG +1,750M BTU
HEATPIi�p11�=CONDI�fONEH. 0-3TONS::: `_
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HF -#1,4* F'& 1„ :_CoNOt1 0NEf2 y5 30yoNS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEA f IiN PWW CONDITIONER;+50:TONS'.
.VENTILATING FANS
EVAPORATIV OO,LERS:::::
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE"ul()ODT"
CLOTHES DRYER
•
GAS LOG
MISCELLANEOUS (NOT COVERED B.SEWf1aERE
UNUSTED GAS APPLIANCE cs00.000 BTU
ULR4STEW GAS APPUW >403=1 STU
USED APPUANCE <400.000 BTU
USED APPLNNCE>400,000 BTL
AIR HANDLER (10.000 CFM
AIR HANDLER >10S:00 CFM
L
2
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.03 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
X 10.00 =
X 10.00 =
X 10.00 =
x 10.00
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
2 00
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
$ 24.00
PLUS: PROCESSING FEE
$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
49.00
=.S
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675