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1992, 10-15 Permit App: 92008946 Mechanical Fixtures
JOB STREET ADDRESS: CITY/STATE/ZIP: tLA14 MECHANICAL PERMIT APPLICATION FORM Information Worksheet OWNER: 'VZO-U MAILING ADDRESS: PHONE NUMBER: / o2 / - '� 3 702 (Street) - (City/State) (Zip) CONTRACTOR: A&M QUALITY HEATING LICENSE NUMBER: _AmQIIAHR] q_Uj 1271 WINPIANA AVE. PHONE NUMBER: 929-2100 SPOKANE, WA 99216 MAILING ADDRESS: (Street) (City/State) (Zip) MECHANICAL WORKS 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 _ _ _ _ _ _ _ _ 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' PTH. 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 >4000000 BTU_ _ _ _ _ _ _ AIR HANDLER <10,000 CFM _ _ _ _ _ _ _ _ AIR HANDLER >10,000 CFM _ _ _ _ _ _ _ _ FEE SCHEDULE NUMBER X EACH OF UNITS ITNIT AMOUNT -X$10.00 - x 25.00 = �- x 10.00 O _..x12.00=ILI, 00 x 15.00 • x 1.00 • ,� , �p 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 - SUBTOTAL S '66 PLUS: PROCESSING FEEI+ $ 25.00 EQUALS: TOTAL PERMIT NOTE: M M P IT £E IS $35.00 FEE DUE SIGNATURE _ Spokane County Department of Buil din sand Safety West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675