1991, 07-25 Permit App: 91004489 Heat PumpMECHANICAL PERMIT APPLICATION FORM
Information Worksheet_
JOB STREET ADDRESS: :4719 N. Sunnyvale Dr. > J// �1c�
CITY/STATE/ZIP: Spokane, WA 99216 PARCEL NUMBER: (.�J' `'l- v C
OWNER: Mike Bergam PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: Allied Heating, Iihc. LICENSE NUMBER: ALLIEI*200D4
MAILING ADDRESS: 9309 E. Trent
PHONE NUMBER: 978-8252
(Street)
Spokane,WA 99206
(City/State) (Zip)
MECHANICAL
DESCRIPTION
WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
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 PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS _
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
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
= AMOUNT
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
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 =
Iv 10.0K)*
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
NOTE: MINIM M PERMIT FEE IS $35.00
SIGNATURE //✓ eZa_ 4J
SUBTOTAL
$ A9.610
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ a 7 00
Spokane County Department of Building_ and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675