1992, 06-26 Permit App: 92004775 Heat Pump MECHANICAL PERMIT APPLICATION FORM
Information Worksheet (c)O7
JOB STREET ADDRESS: /TS.- { ( //'
CITY/STATE/ZIP: 9' 9 z t PARCEL NUMBER:
OWNER: I' utiti/,69- odi,S a PHONE NUMBER: 9'- ° 7
MAILING ADDRESS: SA-e^rQ-
(Street) (City/State) (Zip)
CONTRACTOR: :. . .- .. - . . LICENSE NUMBER: BANNEFF378NT
CONTACT: RUSS LUNDE PHONE NUMBER: 535-1711
MAILING ADDRESS: P.O. Box 4346 Spokane, WA. 99202
(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 8TU(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 =
FIOILER/REFRIG 101 500M BTU x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILER/REFRIG 1,0001,-1,7 0M BTU x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP &AIR CONDITIONER 0-3 TONS x 12.00 = 12- ,3 o 1
HEAT PUMP & AIR CONDITIONER 3-15 TONS x 20.00 =
HEAT PUMP &AIR CONDITIONEi 15 30 TONS x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
HEAT PUMP &AI.R 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 II HOOD 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 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 t3TU x100.00 =
AIR HANDLER <10,000 CFM x 12.00 =
. ......... .......................................................... . .................. . ........... .
AIR HANDLER>10,000 CFM `; x 15.00 =
SUBTOTAL $ j2-V3
PLUS: PROCESSING FEE + $ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE
SIGNATURE
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Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675