1991, 08-08 Permit App: 91004859 Heat Pump MECHANICAL PERMIT APPLICATION FORM
Information Worksheet L)-� �
JOB STREET ADDRESS: • J - j
CITY/STATE/ZIP: •J 6J�)�y r ( a� . G is j PARCEL NUMBER: <a 8�t\-1 T S -/
c_c, e 0.(.. PHONE NUMBER: 9 a_;-C;ct
MAILING ADDRESS: to 1
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(Street) (City/State) (Zip)
CONTRACTOR: e..-1 LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER 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 =
GAS EQUIPMENT<100,000 BTU(INCLUDES 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 =
BOILER/FI EFRIG101-500M BTU x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BO' R/REFRIG 1x0001-1 750M BTU x 35.00 =
BOILER/' -IG +1,750M BTU x 60.00 =
HEAT PUMP AIR CONDITIONER 0-3 TONS X x 12.00 =
HE• • _ ' &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. OF HOOD) x 50.00 =
TYPE H HOOD x 10.00 =
CLOTHES DRYER x 10.00 =
..................................... .
RANGE x 10.00 =-
GAS
GAS LOG x 10.00 =
MISCELLANEOUS(NOT COVEREDELSEWHERE 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 APPLIANCE>400,000 BTU x100.00 =
AIR HANDLER <10,000 CFM x 12.00 =
AIR HANDLER>10,000'CFM x 15.00 =
SUBTOTAL $
PLUS: PROCESSING FEE + $ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE = $
SIGNATURE _
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675