1993, 06-02 Permit App: 93003995 ACJOB STREET ADDRESS:
CITY/STATE/ZIP: \� u ;29.4e4/0 PARCEL NUMBER:
OWNER: 14)t) / ''' PHONE NUMBER: c9 6 D / /
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
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MAILING ADDRESS:
(Street) (City/State) (Zip)
_-
CONTRACTOR: A&M gouryHEATING LICENSE NUMBER: y4oyAu143st
tiairWAHCAVE.
SPOKANE, WA 99216
MAILING ADDRESS:
(Street)
MECHANICAL
DESCRIPTION
PHONE NUMBER: 928-21on
(City/Stag) (Zip)
WORKSHEET/FEE SCHEDULE
OFUNITS X
UNIT
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
AIR CONDITIONER 0-3 TONS
AIR CONDITIONER 3-15 TONS
AIR CONDITIONER 15-30 TONS
AIR CONDITIONER 30-50 TONS
AIR CONDITIONER +50 TONS _
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
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
- AMOUNT
•x$10.00 -
X 25.00 -
X 10.00 -
x 12.00• m
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 -
/a.bO
NOTE:
S IGNATURE
SUBTOTAL
$ /a,00
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT r�
} ERMIT FEE IS $35.00 FEE DUE _ $ 3700
Spokane County Department of Builddi l(and Sa Safety
456-3675
West 1026 Broadway Avenue Spokane, WA
I