1993, 01-08 Permit App: 93000108 Mechanical Fixtures35a'Q ( b1C3
Ke,ki,Leiast -Pada
_�
L✓
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB, STREET ADDRESS: -+p /6a/ etAA�
CITY/STATE/ZIP: �� ZOW / 9aia? PARCEL NUMBER:
q3-(01
OWNER: /64/.642.1
PHONE NUMBER:
MAILING ADDRESS:
(City/State) (Zip)
A&M QUALITY HEATING LICENSE NUMBER: 4NQIIAHR141N1
PHONE NUMBER: 92B-2100
CONTRACTOR:
(Street)
5-8.5--41g7
E 1'ti 11TNDIANA Ail E.
SPOKANE; WA 99216
MAILING ADDRESS:
(Street)
MECHANICAL
DESCRIPTION
WORKSHEET/FEE
NUMBER
OF UNITS
(City/State) (Zip)
SCHEDULE
X EACH
UNIT.
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000
HEATING EQUIPMENT +100,000
GAS PIPING (EA OUTLET)
REFRIG-1 -100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
BTU
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
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
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12'
TYPE II HOOD
PTN. OF 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.-
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 0
x100.00 -
x 12.00
x 15.00 -
dD
NOTE: MIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
$ /a,00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT ��y.
FEE DUE' _' $ 37.00
Spokane County Department of Building_ and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675