1992, 10-28 Permit App: 92009466 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: / V lg. S02
/
CITY/STATE/ZIP: S0-1& 99,9/6 PARCEL NUMBER:
sT / 57
8,a4a Q -144a, •
OWNER: Ede 4'- PHONE NUMBER: 9a -1173
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: A&M QUALITY HEATING LICENSE NUMBER: AMnJAHF.1 43 1141
E 1 n DANA AVE• PHONE NUMBER: 928-2100
SPOKANE; WA 99216
MAILING ADDRESS:
(Street)
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER
XMH
OF 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
0-3 TONS
3-15 TONS
15-30 TONS _
30-50 TONS _
+50 TONS
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
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. is
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 =
/Q. 00
/.tea
,V.00
/,2.0/)
NOTE: MINIMUM PERMIT EE IS $35.00
SIGNATURE
SUBTOTAL
$ 36,0o
PLUS: PROCESSING FEE
EQUALS: TOTAL PERMIT
FEE DUE
+ $ 25.00
= $ 610oo
Spokane County Department of Building_sand Safety
West
1303 Broadway Avenue Spokane, WA 260 (509) 456-3675