2002, 08-19 Permit App: 02007083 ReroofJOB STREET ADDRESS:
CITY/STATE/ZIP:
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
/- /ao
-FD._15
/y77
&4 99a/6
OWNER: /Q.,(4,1.1 ZOQ.A/ J
MAILING ADDRESS:
CONTRACTOR:
PARCEL NUMBER: �f C� p
PHONE NUMBER: f f - d t 0
(Street)
A&M QUALITY HEATING
E- 12'I 1 INDIANA AVE.
SPOKANE; WA 99216
MAILING ADDRESS:
(City/State) (Zip)
LICENSE NUMBER: AMOJIANF191
PHONE NUMBER: 928-2100
(Street)
(City/State) (Zip)
MECHANICAL WO
DESCRIPTION
HE
FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (EA OUTLET)
REFRIG 1-100M BTU (NOT A/C OR HEAT
REFRIG 101-500M BTU
)
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS _
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
UNLISTED GAS APPLIANCE >400,000 BTU_
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
• /
= 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 =
x 12.00 =
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 ws
x 12.00 =
x 15.00 =
..Q0
I ;(.00
�.O()
NOTE:I U RM EE IS $35.00
SIGNATUItE ► �� .
SUBTOTAL
$ 2W.00
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 0
Spokane County Department of Buildinq'and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675