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2013, 06-03 Permit App: 92005339 Heat Pump L5' e o '•`--'' MECHANICAL PERMIT APPLICATION FORM 9 C( ��L` .-, \Q Information Worksheet FO3 JQAl STREET ADDRESS: 1113 S antrhfnrr1 ( WY/STATE/ZIP: Veradale , WA 99037 PARCEL NUMBER: QWN+ER: Joann Day PHONE NUMBER: 924-7127 HAILING ADDRESS: - (Street) (City/State) (Zip) CONTRACTOR: Allied Heating , Inc . LICENSE NUMBER: ALLIEI*200D4 PHONE NUMBER: 928-8252 1I;LING ADDRESS: 9309 E . Trent Spokane , WA 99206 (Street) (City/State) (Zip) 4 MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT = AMOUNT [DUCTWORK SYSTEM x$10. 00 = WOQDSTOVE/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 _ _ 1 x 12. 00 = 12 . 00 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 = 4V*PORATIVE COOLERS x 10.00 = i,YTE I HOOD (PER 12 ' OR 12 ' PTN. OF HOOD) x 50. 00 = '*'YPE II HOOD x 10. 00 = CL9THES DRYER x 10.00 = PAGE x 10. 00 = Gig LOG x 10. 00 = HI;pCELLANEOUS (NOT COVERED ELSEWHERE)_ _ x 10. 00 = UNJ,ISTED GAS APPLIANCE <400, 000 BTU_ _ _ x 50. 00 = JNIISTED GAS APPLIANCE >400,000 BTU_ _ _ x100. 00 = LISP APPLIANCE <400, 000 BTU x 50. 00 = %SSD APPLIANCE >400, 000 BTU x100.00 = AIR2 HANDLER <10, 000 CFM x 12 . 00 = ,I)t HANDLER >10, 000 CFM x 15. 00 = SUBTOTAL $ 12 . 00 PLUS: PROCESSING FEE + $ 25 . 00 EQUALS: TOTAL PERMIT NOTE: MI IMUM ,PERMIT FEE IS $35. 00 FEE DUE = $ 37 . 00 SIGNATURE r /e ( <i�/C?c u% 1 Spokane County Department of Buildingand Safety West 1303 Broadway Avenue Spokane WA 260 (509) 456-3675