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