1991, 07-31 Permit App: 91004640 AC MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: a 3901 S . Sunderland
CITY/STATE/ZIP: Spokane , WA 99206 PARCEL NUMBER:
OWNER: Dave Koehler PHONE NUMBER:
MAILING ADDRESS: _
(Street) (City/State) (Zip)
CONTRACTOR: Allied Heating , Inc . LICENSE NUMBER: ALLIEIi 200D4
PHONE NUMBER: X28-8252
MAILING ADDRESS: 9309 E . Trent Spokane , WA 99206
(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 = /az , cm(\
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. OFHOOD) 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 $ id OO
PLUS: PROCESSING FEE + $ 25. 00
EQUALS : TOTAL PERMIT
NOTE: MIIMUM PERMIT FEE IS $35.00 FEE DUE = $ ,S17 06
SIGNATURE , /7
C 5/ �: ,
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675