1993, 04-19 Permit App: 93002586 Mechanical Fixtures MECH1N!CAL PERMIT AFPLICATiON FORM 4°51L ' Infor.-nation Worksheet
JOB STREET ADDRESS: f• /3 ivy 9/1'L- /auk
CITY/STATE/ZIP:_____ . ilk._ ???../e." _ PARCEL NUMBER:
OWNER: rf�PJ la rc( PHONE NUMBER: ger���6 _
MAILING ADDRESS:J
(Street) (City/State) SUNLOI107,16 (Zip)
CONTRACTOR: Inland Heating & Cooling. _
� LICENSE NUMBER: Si1NL0I101 1B
PHONE NUMBER: 455-4147
MAILING ADDRESS: 3655 Govt. Way 1/12 Coeur d'Alene, Ill 83814
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER I X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
WOODSTOVE/INSERT x 25.00 =
GAS WATER HEATER / x 10.00 = /[) CO
GAS.Eau IPMENT.<100,000BTU (INCLUDES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) / x 15.03 = 41:e-Z)
GAS PIPING(EAOUTLET)` x 1.00 = cp, (5-t) ,
BOILER/REFRIG 1-100M BTU x 12.00 =
BOILER/REFRI001-,-500M BTU x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILERIREFRIG 1,0001-1750M BTU x 35.00 = 1
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP& IR CONDITIONER 0-3 TONS x 12.00 =
HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 =
HEATPUMPi&<. JR CONDITIONER 15-3.0 TONS .>'• x 25.00 =
HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 =
HEAT MPCONDITIONER+50TONS :• x 60.00 =
.VENTILATING FANS x 10.00 =
EVAPORA1WEa QOLERS x 10.00 =
TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD) x 50.00 =
TYPE II- -IOOD. 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 APPUANCE <a00.000 BTU x 50.00 -
ULINSTED GAS APPLIANCE>400.000 STU x100.00
USED APPLIANCE<400.000 BTU x 50.00 -
USED APPLIANCE>400,000 QTU x100.00 -
ArR HAMMER<10.000 CF1.4 I I x 12.00 =
AIR HANDLER>10.000 CFU ' x 15.00 = L
SUBTOTAL S 72- pT) J
PLUS: PROCESSING FEE t S 25.00
NOTE: MINIMUM PERMIT FEE IS 535.00 EQUALS: TOTAL PERMIT
FEEDUE = S �2. Ov
SIGNATURE / I
Spokane County Division of Buildings