1991, 05-01 Permit App: 91002227 Heat Pump 1111k
• it I I ��
MECHANICAL PERMIT APPLICATION FORM A )
Information Worksheet L
JOB STREET ADDRESS: S 4 710 Wood-:11 f f, 1
CITY/STATE/ZIP: Spokane, Wa 99206 PARCEL NUMBER: d
OWNER: Chuck Hafner PHONE NUMBER: 924-0445
MAILING ADDRESS: Same
(Street) (City/State) (Zip)
CONTRACTOR: Sturm Heating, Inc. LICENSE NUMBER: STURMI*210 QF
PHONE NUMBER: ( 509 ) 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
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
x 25.00 =
GAS WATER HEATER x 10.00 =
AS EQ IPMENT i00,t500 DIV INCt_UD S:>': > : :;.``«J
......:. ....:::::.::.:.....:.:::::. :: 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 =
601 # .$04.1::::4 0 gro ... x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOI ER/REI=RIG 1,0001 1,750M 13TU x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP$�AIR CONDITIONER 0-3 TONS 1 X 12.00 = 12 .00
HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
HEATPUMP&AiR CONDITIONER 15-30 TONS x 25.00 =
HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 =
igge U<MP IR CONDITIONER+50 TNO x 60.00 =
VENTILATING FANS x 10.00 =
EVAPORATIVE COOLERS
. ........ .. ................. .. ...... .. ............. - < . .:.::.. x10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
CLOTHES DRYER x 10.00 =
x 10.00 -
GAS LOG 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 A'PLIANCE 000 BTU
x100.00 =
AIR HANDLER<10,000 CFM x 12.00 =
AIRHANDLER>10,000.CFM '
x 15.00 =
SUBTOTAL $
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS $35.00 EQUALS: TOTAL PERMIT
FEE DUE =$ 37 . 00
SIGNATURE .k ti i
Spokane County Division of Buildings
West 1303 iroadway Avenue Spokane, WA 99260 (509) 456-3675