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1989, 06-13 Permit App: 89001738 AC
MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: E 19115 Nixon CITY/STATE/ZIP:Greenacres, Wa. 99016 PARCEL NUMBER: OWNER: Robert Allen PHONE NUMBER: 927-1953 MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: Sturm Heating, Inc. LICENSE NUMBER: STURMI*210 QF PHONE NUMBER: 325-4505 MAILING ADDRESS: E_ 204 Indiana Spokane, Wa. 99207 (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE BER DESCRIPTION OFUUNITS I XUNITH I = AMOUNT DUCTWORK SYSTEM_ _ _ _ _ _ _ _ _ _ _ _ _ WOODSTOVE/INSERT - - - - - - - - - - _ - GAS WATER HEATER_ _ _ _ _ _ _ _ _ _ _ _ HEATING EQUIPMENT <100,000 BTU - - - _ - HEATING EQUIPMENT +100,000 BTU _ _ _ _ _ GAS PIPING (1 - 4 OUTLETS) _ _ _ - - - - GAS PIING (5 OR MORE. EACH:)_ - _ _ _ _ REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) REFRIG 101-500M BTU_ _ _ _ _ _ _ _ _ _ _ REFRIG 501-1,000M BTU_ _ - - - _ _ - - - REFRIG 1,001-1,750M BTU- - - _ - - - - - REFRIG +1,750M BTU _ _ _ _ - - - - - - _ HEAT PUMP & 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_ _ _ UNLISTED 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 x$10.00 = x 25.00 = x 10.00 = x 12.00 = x 15.00 = x 4.00 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 = 1 12.00 _ SUBTOTAL PLUS: PROCESSI14G FEEL+ $ 25.00 EQUALS: TOTAL PERMIT NOTE: MIN M PERMIT FEF IS $35.00 FEE DUE _ $ 37.00 SIGNATURE Spokane County Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675