1992, 09-14 Permit App: 92007575 Mechanical Fixtures•
MECHANICAL PERMIT APPLICATION FORM
Information Wo sheet
JOB STREET ADDRESS:
S fl q C0 5.5
CITY/STATE/ZIPAi c4 g742 P CEL ER:
OWNER:
MAILINC�//ADDRESS :
CONTRACTOR:
OBER: 43L[-
(Street)
(City/Stag)
A&M QUALITY HEATING LICENSE NUMBER: ANqJI 1QVJ1
E 1'ri i"oMA*NA'AVE.
SPOKANE; WA 99216
MAILING ADDRESS:
(Zip)
PHONE NUMBER: 928-2100
(Street)
(City/Stag)
(Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
OF UNIT XUWITH
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 1,001-1,7500 BTU
REFRIG +1,7500 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 =
X10.00_
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 =
0
NOTE: MIT �E IS $35.00
S IGNATURE
SUBTOTAL
PLUS: PROCESSING FEE
EQUALS: TOTAL PERMIT
FEE DUE
_Z Sor)
+ $ 25.00
gpokane County Department of Building_ and Safety
West 1
303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
=$S