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1992, 06-09 Permit App: 92004159 Mechanical Fixtures/- MECHANICAL MECHANICAL PERMIT APPLICATION FORM Information Worksheet, JOS STREET ADDRESS: ¢"a !o15 C\ -X15`1 10-17 CITY/STATE/ZIP: 21044441.V tV WA 902O6 PARCEL NUMBER: PHONE NUMBER: 9a 81 a 3 3 o OWNER: p&-6L4.�y E 4:404.4- c - MAILING ADDRESS: CONTRACTOR: (Street) ARM QUALITY HEATING E. 1E. lfrItrnit At/E. SPOKANE; WA 99216 MAILING ADDRESS: (City/State) LICENSE NUMBER: AMQnANR1QDN1 PHONE NUMBER: 928-2100 (Street) (Zip) (City/State) (Zip) MECHANICAL DESCRIPTION WORKSHEET/FEE SCHEDULE NUMBER OF UNITS xUNIT 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 AIR CONDITIONER 0-3 TONS AIR CONDITIONER 3-15 TONS _ AIR CONDITIONER 15-30 TONS _ AIR CONDITIONER 30-50 TONS AIR CONDITIONER +50 TONS FANS HEAT PUMP & HEAT PUMP & HEAT PUMP & HEAT PUMP & HEAT PUMP & VENTILATING 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 eV - AMOUNT x$10.00 a x 25.00 a x 10.00 a x 12.00. . x 15.00 a x 1.00 a x 12.00,a X 20.00 s x 25.00 es x 35.00 a x 60.00 s x 12.00 a x 20.00 a x 25.00 0 x 35.00 a x 60.00 a x.10.00 w x 10.00 as x 50.00 n x 10.00 x 10.00 0 x 10.00 x 10.00 x 10.00 a x 50.00 a x100.00 w x 50.00 0 x100.00 x 12.00 x 15.00 0 I .'OO /a, 00 ,2,00 NOTE: MI M 9, IT `IEE S35.00 SIGNATURE / SUBTOTAL $ ,24,00 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT �/ FEE DUE _' $ 79.00 Spokane County Department of Buildingqland Safety 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 1