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1990, 01-03 Permit App: 90000042 Heat Pump MECHANICAL- PERMIT APPLICATION FORM ' Informati n Workshe JOB STREET ADDRESS: A) . j�-(' 3() (-17(4 CITY/STATE/ZIP:S mak/ &i4 9m6 PARCEL NUMBER: OWNER: 67‘12,1)1_11 /-----Lii/7-11 Ait- 6 PHONE NUMBER (i-4;c 7- KG' ) 7. MAILING ADDRES : G�yuA - 3S - /3 Street) (City/State) (Zip) CONTRACTOR: LICENSE NUMBER: AA/IPA-Ai-1 (------- N3 ti ) i PHONE NUMBER: q9-6- - 02(06 MAILING ADDRESS: (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT = AMOUNT DUCTWORK SYSTEM x$10. 00 = WOODSTOVE/INSERT x 25. 00 = GAS WATER HEATER x 10 . 00 = HEATING EQUIPMENT <100, 000 BTU x 12 . 00 = HEATING EQUIPMENT +100, 000 BTU x 15. 00 = GAS PIPING (EA OUTLET) x 1. 00 = REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12 . 00 = REFRIG 101-500M BTU x 20. 00 = REFRIG 501-1, 000M BTU x 25. 00 = REFRIG 1, 001-1, 750M BTU x 35. 00 = REFRIG +1, 750M BTU x 60. 00 = HEAT PUMP & AIR CONDITIONER 0-3 TONS _ _ / x 12 . 00 = /0.7, 0 0 HEAT PUMP & AIR CONDITIONER 3-15 TONS _ x 20 . 00 = HEAT PUMP & AIR CONDITIONER 15-30 TONS x 25 . 00 = HEAT PUMP & AIR CONDITIONER 30-50 TONS _ x 35 . 00 = HEAT PUMP & AIR CONDITIONER +50 TONS _ _ x 60. 00 = VENTILATING FANS x 10. 00 = EVAPORATIVE COOLERS x 10. 00 = TYPE I HOOD (PER 12 ' OR 12 ' PTN. OF HOOD) x 50 . 00 = TYPE II HOOD x 10. 00 = CLOTHES DRYER x 10. 00 = RANGE x 10. 00 = GAS LOG x 10. 00 = MISCELLANEOUS (NOT COVERED ELSEWHERE) _ x 10 . 00 = UNLISTED GAS APPLIANCE <400 , 000 BTU _ _ x 50 . 00 = UNLISTED GAS APPLIANCE >400, 000 BTU_ _ x100 . 00 = USED APPLIANCE <400, 000 BTU x 50 . 00 = USED APPLIANCE >400, 000 BTU x100. 00 = AIR HANDLER <10, 000 CFM x 12 . 00 = AIR HANDLER >10, 000 CFM x 15. 00 = SUBTOTAL $ /g,c o PLUS : PROCESSING FEE + $ 25 . 00 EQUALS : TOTAL PERMIT NOTE: NIMUM PERMIT FEE IS $35. 00 FEE DUE = $ 37, 0 SIGNATURE I~ Spokane County Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675