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1992, 08-05 Permit App: 92006104 Mechanical FixturesRey ©,t)� MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: ENi/e? CITY/STATE/ZIP: a4211-" /JI9 99//PARCEL NUMBER: OWNER: 62 ..41i`f'L( , / /2-e'`LJ f--) PHONE NUMBER; MAILING ADDRESS: (Street) CONTRACTOR: A&M QUALITY HEATING E. i fii i(i'i D}AW AVE. SPOKANE; WA 99216 MAILING ADDRESS: 9 al3a (City/State) (Zip) LICENSE NUMBER: 4Opnxx191H1 PHONE NUMBER: 928-2100 (Street) MECHANICAL DESCRIPTION (City/State) (Zip) WORKSHEET/FEE SCHEDULE NUMBER X EACH OF UNITS INUIT 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 & HEAT PUMP & HEAT PUMP & HEAT PUMP & HEAT PUMP & VENTILATING 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 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 = AMOUNT •x$10.00 = x 25.00 • X 10.00 es 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 = Q /L1,00 �, 00 NOTE* SIGNAT UMPE'f 'E'IS/$3 .00 SUBTOTAL PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ /*/(i,Q0 Spo ane County Department of Buiidingland Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675