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1991, 10-14 Permit App: 91006807 Gas PipingJOB STREET ADDRESS: MECHANICAL PERMIT APPLICATION FORM *Oz? ./111\ ,c L E A/itzAith 09-/- 4 Informa ion Worksheet 8a CITY/STATE/ZIPS." ' # ' , WA ?Qo2/2 PARCEL NUMBER: i4Lifo,4 OWNER: MAILING ADDRESS: ,vV7 (Street) PHONE NUMBER: 3 - 741/ k (City/State) (Zip) CONTRACTOR:• A&M QUALITY. HEATING LICENSE NUMBER: E. 1 gi f(r1NDIANKAVE. PHONE NUMBER: SPOKANE; WA 99216 MAILING ADDRESS: (Street) AMQIIAHR199N1 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, 0��-=l_ GAS PIPING (EA OUTLET) REFRIG 1-100M BTU (NOT /C OR HEAT P) 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 44/1 = 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 = x100.00 = X 12.00 = X 15.00 = D .,oc NOTE: MIN SIGNATURE PE IT t LW• _AA./ IS $35.00 SUBTOTAL 6.00 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE Spokane County Department of Buildin sand Safety West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675