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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