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1991, 11-08 Permit App: 91007665 Mechanical FixturesMEGNANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: 3 /S CITY/STATE/ZIP: PARCEL NUMBER: OWNER: /� \! PHONE NUMBER: 5 -37f -,F7710 MAILING ADDRESS: _ (Street) (City/State) (Zip) CONTRACTOR: A&M QUALITY HEATING LICENSE NUMBER: AmQIIANF.19 iNl E. M-MINDIANKAVE. PHONE NUMBER: 928-2100 SPOKANE, WA 99216 MAILING ADDRESS: (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE I NUMBER ( X EACH DESCRIPTION OF UNITS UNIT a AMOUNT 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 & AIR CONDITIONER 0-3 TONS HEAT PUMP & AIR CONDITIONER 3-15 TONS _ HEAT PUMP & AIR CONDITIONER 15-30 TONS _ HEAT PUMP & AIR CONDITIONER 30-50 TONS _ HEAT PUMP & AIR CONDITIONER +50 TONS VENTILATING 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 - _ _ - - _ - _ x$10.00 = x 25.00 _ 1 x 10.00 = _0,00 _ x 12.00. _ ) Sl 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 a x 10.00 = x 10.00 = x 50.00 = x 10.00 a 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 = SUBTOTAL $ C c PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT �D NOTE: M�,NI U IT EE�IS$35.00 _ FEE DUE _ $ SIGNATURE -- S{�okane Count Department of Building "and Safe5ty9) 456-3675 West 1303 Broadwav venue Spokane, WA 99 ( 0