1992, 09-04 Permit App: 92007199 Mechanical Fixtures?cpL.\n�k\ ,7 g1
MECHANICAL PERMIT APPLICATION FORM
Intor.:nation Worksheet
JOB STREET ADDRESS: N. 4621 Larch
97,-7/99
/30(0Z
CITY/STATE/ZIP: Spokane, WA 99716
OWNER: Tom Hickman
PARCEL NUMBER:
PHONE NUMBER: 924-2948
MAILING ADDRESS:
(Street) (City/State) SUNLOI107J6
CONTRACTORInland Heating & CoolingLICENSE NUMBER:
SUNLOI101JB
MAILING ADDRESS:
PHONE NUMBER: 455-4147
(Z
p)
3655 Govt. Way Coeur d'Alene, ID 83814
(Street) (City/State)
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)
GAS PIPING(EA>OtUTLET),:.:'::'_ • 2
• BOILER/REFRIG 1-100M BTU • -
BOILfF %REFAIG 01-00M BT1l-.:::
BOILER/REFRIG 501-1,000M BTU
;BO1LEWREFAIel;00014,750M.13Tti
BOILER/REFRIG +1,750M BTU
110:10,1li .aif► OONDITIONER 0-3 TONST.:.1.
HEAT PUMP & AIR CONDITIONER 3-15 TONS
:HEA is ?; IMP;y t0.0NDITIONEi .J0
RNS
HEAT PUMP &AIR CONDITIONER 30-50 TONS
HE42141 s 4#010NEA450 TONS'
.VENTILATING FANS
EVAPD4:1:04E0,LERS:
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE7I iC))QD
CLOTHES DRYER
RANGE - ..
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHEFtE
UNLISTED GAS APPIJIINCE c400,000 BTU
UUNSTED GAS APPLIANCE >400.000 BTU
USED APPLIANCE <400.000 STU
USED APPLIANCE >40DI/00 BTU
AIR HANDLER <10.000 CFU
AIR HANDLER >10,000 CFM
(Zip)
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 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x10.00 =
x 10.00 =
x10.00 -
x 10.00 =
x 50.00 -
x100.00 =
x 50.00 =
x100.00 -
x 12.00 =
x 15.00 =
12 00
2.00
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE K/
SUBTOTAL
PLUS: PROCESSING FEE
$ 24 BB
+ $ 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