1990, 10-11 Permit App: 90005327 Furnace, PipingMECHANICAL PERMIT APPLICATION FORM
�-- Information Worksheet
JOB STREET ADDRESS:
CITY/STA
OWNER:
MAILING ADDRESS:
CONTRACTOR:
(Street)
A & M QUALITY HEATING, INC.
E. 12710InJnana
Spotiarer _.� "a ;} ;3 99216
(City/State) �/ {Zip)
LICENSE NUMBER: /f Qa/?,4' /93,21/
PHONE NUMBER: 7A g -t /60
MAILING ADDRESS:
(Street)
ORKSHEET/FEE SCHEDULE
DESCRIPTION
NUMBER
OF :UNITS
DUCTWORK SYSTEM_
WOODSTOVE/INSERT
GAS WATER HEATER _
HEATING EQUIPMENT <100,000
HEATING EQUIPMENT +100,000
GAS PIPING (EA OUTLET)
REFRIG 1-100M BTU (NOT A/C
REFRIG 101-500M BTU_ _ _
REFRIG 501-1,000M BTU_ _
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I ,:HOOD;- (PEE , _1;75R-12. '
TYPE II HOOD
CLOTHES DRYER__ -
RANGE
GAS LOG-
MISCELLAANEOUS(NOT COVERED
UNLISTED GAS APPLIANCE <400,
UNLISTED GAS APPLIANCE >400,
USED APPLIANCE <400,000 BTU_
USED APPLIANCE >400,000 BTU„.
AIR HANDLER <10,000 CFM _
AIR HANDLER >10,000 CFM
BTU
BTU
OR HEAT PUMP)
0-3 TONS
3-15 TONS_
15-30 TONS
30-50 TONS
+50 TONS
PTN v OFT WOW
ELSEWHERE)_
000 BTU
000 BTU_
f
f
SUBTOTAL
X EACH
UNIT
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
AMOUNT
la
f.co0
(3r 0
PLUS: PROCESSING FEE
NOTE:
SIGNATURE
SPE
FEE DUE
Spokane Conn'
West 1303 Broadway
epartment of Building and Safe
ka9'9
enue Spokane, WA 260 (5 09) 456-3675