1991, 12-12 Permit App: 91008510 Mechanical Fixtuers�3^ 35L l
1V\
\c)I LoM- ST Gu
4y
JOB STREET ADDRESS: e�19 Ute 35.2 /
OA 7 9&o(o PARCEL NUMBER:
PHONE NUMBER: 90W -47g56
91 85/0
MECHANICAL PERMIT APPLICATION FORM
atkak 1 : ?y5a
-,Information Worksheet
CITY/STATE/ZIP:
OWNER: CL -r -19-1544-216;
MAILING ADDRESS:
(Street)
CONTRACTOR:
(City/State) (Zip)
A&M QUALITY HEATING LICENSE NUMBER: QuAssioau:
E.12fl61NDIANA MJE.
SPOKANE; WA 99216
MAILING ADDRESS:
PHONE NUMBER: 928-2100
(Street)
(City/State)
(Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
OF UNITS KUNITx
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.-
% 15.00 -
X 1.00. -
X 12.00,
x 20.00 o
x 25.00 .o
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 -
10.06
19,00
.0o
ia,on
NOTE: MIN MP RMI 3A'E`EEAIS $35.00
,SIGNATURE
SUBTOTAL
S 36, oo
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= s (0/00
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675