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1992, 06-25 Permit App: 92004726 Heat Pumpx{5223.01�o 9Z-4-LZ� p'c MECHANICAL PERFtio APPLICATION FORM Uj p�� �p�j � Information Worksheet pZ JOB STREET ADDRESS: 11E / o fA CITYISTATE/ZIP: a/ e, PARCEL NUMBER: OWNER: PHONE NUMBER: 3- 70 40 MAILING ADDRESS: (Street) (City/State) (zip) CONTRACTOR: Aanner F,rnare F Fue .LICENSE NUMBER: BANNEFF378NT CONTACT: RUSS LUNDE PHONE NUMBER:535-1711 MAILING ADDRESS: F.O. Box 4346 Spokane, WA. 99202 (Street) (CitylState) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODSTOVEJINSE14T GAS WATER HEATER GAS EQUIPMENT <100,00013TU (INCLUDES GAS EQUIPMENT +100,000 BTU DUCTWORK) GAS PIPING (EA OUTLET) BOILER/REFRIG 1-1 DOM BTU BOILER/REFRiG 101-500M BTU BOILER/REFRIG 501-1,000M BTU BOILERIREFRIG`1,0001-1;750M BTU BOILER/REFRIG +1,750M BTU HEAT PUMP &AIR CONDITIONER 0-3 TONS HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT PUMP &AIR CONDITIONER 15-30 TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS HEAT PUMP & AIR CONDITIONER +50 TONS VENTILATING FANS EVAPORATIVE 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 ULINSTED GAS APPLIANCE >400,000 BTU USED APPLIANCE <400,000 BTU USED APPLIANCE >400,000 BTU AIR HANDLER <10,000 CFM AIR HANDLER >1 0,000 CFM '... NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE NUMBER OF UNITS SIGNATURE XEACH UNIT =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 = x12.00 = 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 = x 10.00 = x 50.00 = X100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = /.2.- SUBTOTAL $ 12. - PLUS: PROCESSING FEE +$ 25.00 EQUALS: TOTAL PERMIT FEE DUE 7° I=$ 37- Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675