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1993, 05-17 Permit App: 93003572 AC
JOB STREET ADDRESS: CITY/STAT )(ZIP: OWNER: MECHANICAL PERMIT APPLICATION FORM Intormatio orksheet , (3/1. t / 9Wa,‘ MAILING ADDRESS: et44 (Street) CONTRACTOR: A&M QUALITY HEATING E1gTi iINOIIANA'AVE. PARCEL NUMBER: PHONE NUMBER: SPOKANE, WA 99216 MAILING ADDRESS: LICENSE PHONE 7Q.7- C) - Q©0 9 (City/State) (Zip NUMBER: AMQUANE19IN1 NUMBER: 928-21.00 (Street) (City/State) MECHANICAL WORKSHEET/PEE SCHEDULE OFUUNITS EACHUI 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 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. 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 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 is 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 as NOTE: SIGNATURE__ M .ERM T FE IS $35.00 Spokane County Department of Building"and Safety West Broadway Avenue Spokane, WA 99260 (509) 456-3675 Ioab SUBTOTAL S /1..i PLUS: PROCESSING FEE + $ 25.0 EQUALS: TOTAL PERMIT 2 FEE DUE = $ 37 .ec