1992, 06-29 Permit App: 92004811 Heat Pump MECHANICAL PERMIT APPLICATION FORM Z $ I
Information Worksheet x.135
JOB STREET ADDRESS: / 4 :at, /47/4
CITY/STATE/ZIP: f, 6 . ,. W,t PARCEL NUMBER:
OWNER: PHONE NUMBER:
MAILING ADDRESS:
SMITHQ (City/State) (Zip)
CONTRACTOR: c E 1�2 N0�31 LICENSE NUMBER:
CPOKAttE,WA 99207
(509)328-4431 PHONE NUMBER:
MAILING ADDRESS: WAYNESH2558NJ
(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/REFRIG 101-500M BTU x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILER/REFRIG 1,0001-1,750M BTU x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP &AIR CONDITIONER 0-3 TONS r x 12.00 = i t�°
HEAT PUMP &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 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 BTU x100.00=
AIR HANDLER<10,000 CFM x 12.00 =
AIR HANDLER>10,000 CFM x 15.00 =
SUBTOTAL $ /2.
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE _$ /
SIGNATURE •
5 1
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675