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1992, 12-17 Permit App: 92011040 Mechanical FixturesJOB STREET ADDRESS: CITY/STATE/ZIP: OWNER: 424-6/yL) Q2. 1454 MECHANICAL PERMIT APPLICATION FORM_�iuSKi 5 157 Information Worksheet EctA,t /4,3/8 131 L-1 -. , 6; PARCEL NUMBER: $5401/ • O1/I PHONE NUMBER: 9a �— o MAILING ADDRESS: (Street) CONTRACTOR: (City/Stag) (Zip) A&M QUALITY HEATING LICENSE NUMBER: AMQIIAHR191141 E.1 friMANAIAVE. SPOKAIYM; WA 99216 MAILING ADDRESS: PHONE NUMBER: 928-2100 (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE OFUUNIITTS xUWIITH 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 1,001-1,750M BTU REFRIG +1,750M BTU HEAT PUMP & HEAT PUMP & HEAT PUMP & HEAT PUMP & HEAT PUMP & VENTILATING AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER FANS 0-3 TONS 3-15 TONS 15-30 TONS 30-50 TONS +50 TONS 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 (Zip) = AMOUNT X$10.00 = x 25.00 = x 10.00= X 12.00. _ X 15.00 = x„ 1.00. - X 12.00,"B 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, DD 0 i3 NOTE: MIN%M IT 1EE IS $35.00 SIGNATURE ='-�- � � SUBTOTAL PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ 10,00 Spokane County Department of Buildinq'and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675