1991, 10-03 Permit App: 91006498 Mechanical FixturesMECHANICAL PERMIT APPIAC1tTION FORM
Informatj on Worksheet �/ j,(
JOB STREET ADDRESS:S `C/�iLVliV1, WA.
/ ! 03�
QL W,A 97 /
� CEL NUMBER:
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CITY/STATE/ZIP:
OWNER:
MAILING ADDRESS:
CONTRACTOR:
PHONE NUMBER:
(Street)
A&M QUALITY HEATING
E. 101-trINDIANAIAVE.
SPOKANE; WA 99216
MAILING ADDRESS:
(City/State
LICENSE NUMBER:
PHONE NUMBER:
(Street)
AMQIIAHR l4 3Dj 1
(Zip)
928-2100
(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
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
c.�
= AMOUNT
x$10.00 =
x 25.00 =
X 10.00 =
x 12.00 =
x 15.00 •
X 1.00 =
X 12.00=1
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 =
�..d1
NOTE: M T UM P RMIT $35.00
SIGNATURE �'-4429
SUBTOTAL
PLUS: PROCESSING FEE
25.00
EQUALS: TOTAL PERMIT
FEE DUE
cif 1)
S okane County Department of BuiIdinq'and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675