1992, 12-02 Permit App: 92010576 Mechanical FixturesJ -3Q) 1)(C " 7) L)
JOB STREET ADDRESS:
CITY/STATE/ZIP:
OWNER:
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
Si -Lt 36/?
id/ 990‘, PARCEL NUMBER:
PHONE NUMBER: ; 6 - a/�
MAILING ADDRESS:
CONTRACTOR:
MAILING ADDRESS:
(street)
A&M QUALITY HEATINQ
E. 11710INDIANAVE.
SPOKANE; WA 99216
(City/State) (Zip)
LICENSE NUMBER: ____ y:
PHONE NUMBER: 42$-2104
(Street)
(City/State)
MSCEIANICAL WORKSHEET/FEE SCHHEEDULI
DESCRIPTION OF URNS XUWIT
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 1,001-1,750K BTU
REFRIG +1,750M BTU
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
EVAPORATIVE
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
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
1
(Zip)
AMOUNT
•x810.00 -
x 25.00 -
x 10.00 .-
x 12.00.=
x 3.5.00 -
x„ 1.00
x 12.00, 1
x20.00•
x 25.00.=
x
5.00. -
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 -
1g ,ori
NOTE: MI IM M PERMIT FEE IS $35.00
SIGNATURZk
SUBTOTAL
S
PLUS: PROCESSING FEE + $ 25.0C
EQUALS: TOTAL PERMIT
FEE DUE _ $ 6/00
Spokane County Department of Buildin sand Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675