1991, 07-29 Permit App: 91004576 Heat PumpMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: 3718 S. Union Ct.
CITY/STATE/ZIP:Spokane. WA 99206
OWNER: Robert Miller
PARCEL NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street)
CONTRACTOR: Allied Heating, Inc.
MAILING ADDRESS:
9309 E. Trent
(City/State) (Zip)
LICENSE NUMBER: ALLIEI*200D4
PHONE NUMBER: 928-8252
(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
EVAPORATIVE
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
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
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE .�c'.��'�% k J
• .
SUBTOTAL
= 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 =
%, 10.0V
X50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ oo
Spokane County Department of Building_ and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509
456-3675