1992, 08-18 Permit App: 92006555 Heat Pump, ACJOB STREET ADDRESS:
CITY/STATE/ IP:
OWNER: c� t
MAILING ADDRESS:
LS -5
MECHANICAL PERMIT APPLICATION FORM
Inform ion Worksheet
N )/e )-fS
Cc) A 9 CEL NUMBER:
CONTRACTOR:
• N= mow %97,4—g7-3/
(Street)
(City/State) (Zip)
A&M QUALITY HEATING LICENSE NUMBER: .MnJJKti4
E. 17111KnAVE
SPOKANE; WA 99216
MAILING ADDRESS:
PHONE NUMBER: 928-unn
(Street)
(City/Stag)
MECHANICAL WORKSHEET/PEEESSCCHHEEDULE
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 +1,750M 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
•
(Zip)
- AMOUNT
•x$10.00 •
X 25.00 •
X 10..00 •
x 12.00. •
x 15.00 •
X• 1.00
X 1.2.00.
X 20:00 •
x 25.00.m
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 -
1V Ii)
NOTE: MINJI P, RMIT EE IS $35.00
SIGNATUKE
SUBTOTAL •
S ia4 D
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE : $37- e
Spokane County Department of Buildinq'and Safety
West 1303 Broadway Avenue Spokane, WA 99260 009) 456-3675