1991, 10-28 Permit App: 91007244 Furnace, PipingJOB STREET ADDRESS:
CITY/STATE/ZIP:
OWNER:
MECHANICAL PERMIT. APPLICATION FORM
Informatipn.Worksheet
(9aG _AA dug
MAILING ADDRESS:/A/YLIQ
(Street)
CONTRACTOR:
A&M QUALITY HEATING
r:1016IN )DANA AVE.
SPOKANE; WA 99216
MAILING ADDRESS:
ARCEL NUMBER:
PHONE NUMBER:
(City/State) (Zip)
513. 02,0
LICENSE NUMBER: AMTIAHF1Q1H1
PHONE NUMBER: 998-9100
(Street)
(City/State)
(Zip)
MECHANICAL
DESCRIPTION
WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS 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
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 <16,000 CFM
AIR HANDLER >10,000 CFM
= AMOUNT
X$10.00 -
x 25.00 =
x 10.00 -
x 12.00 =
x 15.00 c
x 1.00 =
x 12.00,c
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. .o)
.c t)
NOTE:
SIGNATURE
IT re E IS $35.00
SUBTOTAL
$ )N.o0
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675