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1992, 07-16 Permit App: 92005357 ACi519A. 1-kao5 L -o ITA 5 JOB STREET ADDRESS: CITY/STATE/ZIP: OWNER: MAILING ADDRESS: r Q12-5357 MECHANICAL PERMIT APPLICATION FORM Information Worksheet E. 0 /36/7 ;n€: -' WA / 9.2/LpARCEL NUMBER: PHONE NUMBER: 9a l/- s3 a 6 CONTRACTOR: (Street) A&M QUALITY HEATING E. 1fi TdlNGIANA AVE. SPOKANE; WA 99216 MAILING ADDRESS: (City/State) (Zip) LICENSE NUMBER: AMOVIANY 19 AN PHONE NUMBER: 928-7100 (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH OF UNITS [MIT. 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 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 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 HEAT PUMP & HEAT PUMP & HEAT PUMP & HEAT PUMP & HEAT PUMP & VENTILATING - AMOUNT 410.00 - x 25.00 a X 10.00 - x 12.00.E x 15.00 a X 1.00 - x 12.00,a x 20.00 a x 25.00.a x 35.00 a x 60.00 - x 12.00 a x 20.00 a x 25.00 a x 35.00 a x 60.00 a x 10.00 a x 10.00 a x 50.00 a x 10.00 - x 10.00 a X 10.00 a x 10.00 - x 10.00 a x 50.00 a x100.00 - x 50.00 a x100.00 a x 12.00 a x 15.00 a NOTE: MINIMUM PE SIGNATURE E�S.00 SUBTOTAL $ /Loo PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ 37,00 Spokane County Department• of Building:and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675