1992, 08-20 Permit App: 92006685 Mechanical FixturesJOB STREET ADDRESS:
CITY/STATE ZIP:
OWNER:
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
E _Hou V
Si
���a/ggil &1A / t l' PARCEL NUMBER:
MAILING ADORES
CONTRACTOR:
PHONE NUMBER: 9a F— 3 a .oh
(Street) (City/State)
AAM QUALITY HEATING LICENSE NUMBER: wynpmxzialmi
r ri roiNDIAN AVE.
SPOKANE; WA 99216
MAILING ADDRESS:
PHONE NUMBER:
(Street)
(Zip)
92R -210Q
(City/Stag)
MECHANICAL WORKSHEET/PEE SCHEDULE .
ES
OF UNITS xUNIT
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 +1,750X 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
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
EVAPORATIVE
COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. Or 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
000
5
(Zip)
• AMOUNT
x$10.00 -
x 25.00 -
x 10.00
x 12.00.=
x 15.00 -
x 1.00
X12.00,4=
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 -
5, 0 0
NOTE:
SIGNATURE
M IMUM PE'_ IT EE I $35.00
SUBTOTAL
S oo
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE = S
Spokane County Department of Buildin 'and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675