1991, 12-18 Permit App: 91008705 Gas Log, Piping MECHANICAL PERMIT APPLICATION FORM �1
Information` W rksheet G I _ (O 5
JOB STREET ADDRESS: L ( U � 6S `� t � L a 9c�
CITY/STATE/ZIP: AQ, my) 9 fJ EL NUMBER:
OWNER: A Q.n/L.-, PHONE NUMBER: l Z cJ -- 0 6 4;r4--C-(
MAILING DRESS:
(Street) - (City/State) (Zip)
CONTRACTOR: A&M eQ�UALIITY HEATING LICENSE NUMBER: Amy/alit].
11r1.V i1014N/jiAVE. PHONE NUMBER: 928-2100
SPOKANE, WA 99216
MAILING ADDRESS:
(Street) - (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT • AMOUNT
DUCTWORK SYSTEM .. 2410.00 =
WOODSTOVE/INSERT x 25.00 -
GAS WATER HEATER x 10.00 •
HEATING EQUIPMENT <100,000 BTU _ _ _ _ _ x 12.00•=
HEATING EQUIPMENT +100,000 TU _ _ _ x 15.00 =
GAS PIPING (EA OUTLET) J., _ _ _ 'Mir
_ _ ( X 1.00 • t. p D
REFRIG 1-100M BTU (NOT A/C OR HEA PUMP) X 12.00. =
REFRIG 101-500M BTU x 20.00 =
REFRIG 501-1,000M BTU x 25.00 =
REFRIG 1,001-1,750M BTU x 35.00 =
REFRIG +1,750M BTU x 60.00 =
HEAT PUMP & AIR CONDITIONER 0-3 TONS _ X 12.00 =
HEAT PUMP & AIR CONDITIONER 3-15 TONS _ x 20.00 •
HEAT PUMP & AIR CONDITIONER 15-30 TONS _ x 25.00 =
_
HEAT PUMP & AIR CONDITIONER 30-50 TONS x 35.00 =
HEAT PUMP & AIR CONDITIONER +50 TONS x 60.00 =
VENTILATING FANS x 10.00 =
EVAPORATIVE COOLERS x 10.00 =
TYPE I HOOD (PER 12 ' OR 12' PTN. OF HOOD) X 50.00 =
TYPE II HOOD x 10.00 =
CLOTHES DRYER x 10.00 =
RANGE X 10.00 =
GAS LOG f x 10.00 = / D .66
MISCELLANEOUS (NOT COVERED ELSEWHERE)_ _ x 10.00 =
UNLISTED GAS APPLIANCE <400,000 BTU _ _ x 50.00 =
UNLISTED GAS APPLIANCE >400,000 BTU_+ _ _ x100.00 =
USED APPLIANCE <400,000 BTU x 50.00 =
USED APPLIANCE >400,000 BTU x100.00 =
AIR HANDLER <10,000 CFM x 12.00 =
AIR HANDLER >10,000 CFM x 15.00 =
Z SUBTOTAL $ Ii .0 0
A 1 r k/i"trje PLUS: PROCESSING FEE + $ 25.00
'�►►�
EQUALS .,
TOTAL PERMIT ' ', 6.00� ��
NOTE: 1'N 'i U' ' ' IT dEE IS $35. 00 FEE DUE = $
SIGNATuI E �� __ /_ 1*,rr. ,.
Spokane County Department of Buildin "and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675