1992, 09-04 Permit App: 92007184 Mechanical Fixtures(et) 11 • Okkp S� ( MECHANICAL PERMIT APPLICATION FORM
5k15
�6,,,ktJ L $ I Infer.-nabon Worksheet
JOB STREET ADDRESS: 4513 N. Larch
CITY/STATE/ZIP: Spokane, WA 99216
OWNER: Don May
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PARCEL NUMBER:
PHONE NUMBER: 926-6587
MAILING ADDRESS:
(Street) (City/State) SUNLOI¢107J6 (Zip)
CONTRACTOR:Inland Heating LICENSE NUMBER:SUNLOI101JB
PHONE NUMBER: 455-4147
MAILING ADDRESS: 3655 Govt. Way Coeur d'Alene. TD 81814
(Street)
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER
DESCRIPTION OF UNITS
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER 1
GAS EQUIPMENT'<100,000 BTU (INCLUDES
GAS EQUIPMENT+100,000 BTU DUCTWORK) 1
GAS' PIPING'::.�'OUTLET) EA'2
:....._�,..
BOILER/REFRIG 1-100M BTU
BOILEWREFFt.IGt}t'yr00M,BTU.
BOILER/REFRIG 501-1,000M 811.1
BOILER/REFRIG t,000;1-1;750MBTU:: ;
BOILER/REFRIG +1,750M BTU
HEAT P Ifit1P<$„ TI CONDIPONER 0-3 TONS -.
HEAT PUMP & AIR CONDITIONER 3-15 TONS
11EAt MPWA11 CONDITIONER 15 0JONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
°HEAT PL P rCONO)17ONER+50TONS`..
VENTILATING FANS
EVAPORATIVE,; 30LERIS ,.:..
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE lf}ll()N 011)�;:,.<- ,•
CLOTHES DRYER
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400A00 BTU
UL NSTED GAS APPUANCE >400AO0 BTU
USED APPUANCE <COOA00 BTU
USED APPUANCE >C00 BTU
AIR HANDLER <10.000 CF7A
AIR HANDLER >10,000 CFR
X EACH
UNIT
= AMOUNT
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 =
x25.00 =
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 =
10.00
15.00
2.00
NOTE: MINIMUM PERMIT FEE IS $35.00
SUBTOTAL
$ 27.00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
52.00
=S
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675