1993, 02-26 Permit App: 93001087 Mechanical Fixtures CA 7tY- 1(A-1
MECHANICAL PERMIT APPLICATION FORM
(� Information Worksheet ( D-7 (• )
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JOB STREET ADDRESS: /245-4 /7 \S
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CITY/STATE/ZIP: i 19.2/�i PARCEL NUM
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OWNER: 4- PHONE NUMBER: 9 to -, 6 0 l
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: A&M QUALITY HEATING LICENSE NUMBER: ANQIIAHRl4iN1
1iAwAVE• PHONE NUMBER: 928-2100
• SPOKANE, WA 99216
MAILING ADDRESS:
(Street) • (City/State) (Zip)
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MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS MIT = AMOUNT
DUCTWORK SYSTEM .. •410.00 =
WOODSTOVE/INSERT x 25.00 _
GAS WATER HEATER • • X 10.00 • /D. DO
HEATING EQUIPMENT <100,000 BTU _ _ I X 12.00. _ AQ, /O
HEATING EQUIPMENT +100,000 BTU x 15.00 =
GAS PIPING (EA OUTLET) a X 1.00 - , ra D
REFRIG 1-100M BTU (NOT A/C OR HEAT 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 X 10.00 =
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 =
SUBTOTAL $ a4{, 00
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT
NOTE: MINIM 'ERMIT FEE IS $35.00 FEE DUE = $ I/9, 0 0
SIGNATURE "241,t/ It.. ./
Spokane County
Department
SeS Safety
West 1303 Broadway Ana Spokane, WA99260 (509) 456-3675