1991, 03-26 Permit App: 91001374 Furnace, PipingJOB STREET ADDRESS:
CITY/STAT /ZIP:
MECHANICAL PERMIT APPLICATION FORM
Information Works
87 )61,16)
PARCEL NUMBER: 215
OWNER: PHONE NUMBER: gr1.4i/
MAILING DRESS:
CONTRACTOR:
MAILING ADDRESS:
(Street)
A & M QUALITY HEATING LC.
E. 12710 Indiana
Spokane, Washington 99216
6
(City/State)
LICENSE NUMBER
PHONE NUMBER:
144
(Street)
(Zip)
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE.
NUMBER X EACH
OF UNITS UNIT
DESCRIPTION
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 PUMP
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
EVAPORATIVE
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
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 12.0O:=
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 =
x 12.00 =
x 15.00 =
/ -t
NOTE: MINIMUM PERNW:ic;S $35.00
,QA
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
SIGNATURE
SUBTOTAL
PLUS: PROCESSING FEE
$ gs•oe)
$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ Sob