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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 pc) . (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