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1992, 05-26 Permit App: 92003702 Heat Pump
MECHANICAL PERMIT APPLICATION FORM Intoreati n Worksheet JOB STREET ADDRESS: -5 757 -3 6 / i"k `7 B7oa icecot • CITY/STATE/ZIP: 6 Ia/ '{J/ 9 ? 26frARCEL NUMBER: 1//Uta'Or'At OWNER: MAILING ADDRESS: CONTRACTOR: MAILING ADDRESS; PHONE NUMBER: (Street) A&M QUALITY HEATING E. 127,61N/31 -ANA -AVE. SPOKANE, WA 99218 ci — (City/State) (Zip) LICENSE NUMBER: PHONE NUMBER: (Street) J$tJ �imI 221-2-110 (City/Stag) MECHANICAL WORKSHEET/FEESCHHEEDULE. g�► OF LTESx MIKNITB DESCRIPTION DUCTWORK SYSTEM WOODSTOVE/INSERT GAS WATER HEATER HEATING EQUIPMENT <100,000 BTU HEATING EQUIPMENT +100,000 BTU GAS PIPING (EA OUTLET) REFRIG 1-100M BTU (NOT A/C OR HEAT PUM?) REFRIG 101-500M BTU REFRIG 501-1,000M BTU REFRIG 1,001-1,750K BTU REFRIG +1,750M BTU AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER FANS HEAT PUMP & HEAT PUMP & HEAT PUMP & HEAT PUMP & HEAT PUMP & VENTILATING 0-3 TONS 3-15 TONS 15-30 TONS 30-50 TONS +50 TONS Imp 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 (Zip) - AMOUNT •x;10.00 • X 25.00 - X 10.00 .• X 12.00. so 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 - /a .(OO NOTE: MINIMUM PERMI FEE IS $35.00 SIGNATURE_.____ SUBTOTAL PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE a 5 3 d0 Spokane County Department."of Building"and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675