1990, 06-04 Permit App: 90002472 AC MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: N. 1226 Skipworth
CITY/STATE/ZIP: Spokane, Wa. 99206 PARCEL NUMBER:
OWNER: Wayne Williams PHONE NUMBER: 928-5767
MAILING ADDRESS: SAME
(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
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 (1 - 4 OUTLETS) x i , c;o =
GAS PIING (5 OR MORE. EACH: ) 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 =
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 $ 12 .00
PLUS: PROCESSING FEE + $ 25. 00
EQUALS: TOTAL PERMIT
NOTE: M IMUM PERMI FEE IS $35.00 DUE = $ 37 .00
SIGNATURE i,c_,ti-v1 GUE---)Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675