1991, 07-30 Permit App: 91004601 Heat Pump, Gas LineMECHANICALSEHMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: l 1403 MA/14
CITY/STATE/ZIP:
OWNER: r .;. ; WJ akideafti
MAILING ADDRESS: Q0' MA/17
(Street)
CONTRACTOR: RL//77,(a
PARCEL NUMBER:
PHONE NUMBER: Ch&-$/bI
,VTnC x 4206
(City/State) (Zip)
LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
DESCRIPTION
(Street)
/OA
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER
GAS EQUIPMENT <100,000 BTU (INCLUDES
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS, PIPING (EA OUTLET)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 101-500M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,0001-1,750M BTUs::.., ::_ ;- "_':-_-,,_
BOILER/REFRIG +1,750M BTU
HEAT. P.UMP & AIR CONDITIONER 0-3:TONS::.
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT`PUMP & AIR CONDITIONER 15-30 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)
TYPE II:HOOD
CLOTHES DRYER
RANGE,.
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE>400,000.BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER>10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
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 =
,/
/
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= 5
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675