1993, 02-10 Permit App: 93000784 Mechanical FixturesRkycN)
JOB STREET ADDRESS:
CITY/STATE/ZIP:
A2/112)
OWNER:
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
f71S/5 19,64,cJ,,) c
2 2o2
cVA 9i ?PARCEL NUMBER:
PHONE NUMBER: % oC�q 67
MAILING ADDRESS:
CONTRACTOR:
MAILING ADDRESS:
(Street)
A&M QUALITY HEATING
E. 12/41101441,1E.
71u41/E.
SPOKANE; WA 99216
(City/State) (Zip)
LICENSE NUMBER: AMQu4HR1 Q N1
PHONE NUMBER: 920-21A0
(Street)
MECHANICAL
DESCRIPTION
(City/State) (Zip)
WORKSHEET/FEE SCHEDULE
OFUUNITS xUWITx
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. 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
• AMOUNT
•X$10.00 =
X.25.00 =
X 10.00 =
x 12.00.=
x 15.00 es
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 0
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
.nn
NOTE: MI> MUM PERMITT FEE IS $35.00
SIGNATURE
SUBTOTAL
$ a4'. oo
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE = $ /19 OQ
Spokane County Department of Buildinlfand Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675