1992, 07-14 Permit App: 92005052 Heat Pump �� '`,, N� 3_ MECHANICAL PERMIT APPLICATION FORM 1
/
_.121.---D information Worksheet ,J
JOB STREET ADDRESS:
.s e- T i
CITY/STATE/ZIP: - 77.71 i PARCEL NUMBER: ' ' �_.,, / J , t '�yC'�
OWNER: .T€.ty AZ(TG A . PHONE NUMBER: FZ V .5'0 ° f
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: RannPr Furnace & Fuel, Inc.LICENSE NUMBER: BANNEFF378NT
CONTACT: RUSS LUNDE PHONE NUMBER: 535-1711
MAILING ADDRESS: P.O. Box 4346 Spokane, WA. 99202
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
. ....................................................................................................................................
WOODSTOVE/INSERT.:.: : ::'. <': ? ;'::::.< ... . x 25.00 =
GAS WATER HEATER x 10.00 =
GAS EQUIPMENT<100000bTU(INCLUDES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING (EA OUTLET) x 1.00 =
BOILER/REFRIG 1-100M BTU x 12.00 =
EOILER/REFRIG :101 ,500M:g'1 U ......... .:. ; .... x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILER/REFRIG 1:;0001 °'.;1,T5OM BTU; x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP & AIR CONDITIONER 03 TONS 1 x 12.00 = /2' tr
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 I x 10.00 =
MISCELLANEOUS`(NOT:COVERED'ELSEWHERE ' x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTED GAS APPLIANCE>400,000 BTU :: x100.00 =
...::.....
USED APPLIANCE<400,000 BTU x 50.00 =
USED APPLIANCE400000 BTU x100.00=
AIR HANDLER <10,000 CFM x 12.00 =
AIR HANDLER>10,000 CFM x 15.00 =
SUBTOTAL $ /2_ • '
PLUS: PROCESSING FEE + $ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$ 37 b . 1
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675