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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