1992, 08-03 Permit App: 92005965 AC .
/2
MECHANICAL PERMIT APPLICATION FORM ��7
Information Worksheet \/ Al
JOB STREET ADDRESS: [� / J0 / 'SA/VaAftj' 1 '- i'' .
CITY/STATE/ZIP: � &A 9'Z /( PARCEL NUMBER: V5�1/. 2-A5/
o��D - ', t D 9
OWNER: Y,&v- a,vL) 4)64-i--- PHONE NUMBER: 9
MAILING ADDRESS:
(Street) - (City/Stats) (Zip)
CONTRACTOR: A&M QUALITY HEATING LICENSE NUMBER: •iQ Asswn 1
E 'f lf)b4cJA AVE. PHONE NUMBER: 928-2100
SPOKANE; WA 99216
MAILING ADDRESS:
(Street) (City/Stag) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION OFFUUNBIITTS XUa TCH = AMOUNT
DUCTWORK SYSTEM •x$10.00 =
WOODSTOVE/INSERT x 25.00 _
GAS WATER HEATER X 10.00 -
HEATING EQUIPMENT <100,000 BTU _ _ X 12.00 =
HEATING EQUIPMENT +100,000 BTU x 15.00 -
GAS PIPING (EA OUTLET) X 1.00
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 = / / 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. Or 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 $ /a.0 o
PLUS: PROCESSING FEE + $ 25.00
^
EQUALS: TOTAL PERMIT
NOTE: MI UM :,,i IT FE IS $35.00 FEE DUE- !-- = $ 37. 00
SIGNATURE_____ _ / _
Spokane County Department of Building and Safety
West 1
303 Broadway Avenue Spokane, WA 99260 (509) 456-3675