1997, 05-15 Permit App: 97003154 Gas Log, Piping MECHANICAL PERMIT APPLICATION FORM
Informaation Worksheet \(n7
JOB STREET ADDRESS: Ea.4.2t / 5/.o ' .
CITY/STATE/ZIP: / 9 9.2/( PARCEL NUMBER: /� ,/ Q
OWNER: PHONE NUMBER: 9� `t - 1/3 D 7
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: A&M QUALITY HEATING LICENSE NUMBER: Anps 91H,
t 1 ffritil l(?IANA AVE. PHONE NUMBER: 928-2100
SPOKANE, WA 99216
MAILING ADDRESS:
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS MIT = AMOUNT
DUCTWORK SYSTEM •x$10.00 -
WOODSTOVE/INSERTX 25.00 =
-
GAS WATER HEATER 1 X 10.00 = /0 , 00
HEATING EQUIPMENT <100,000 BTU _ j x 12.00. seig.b D
HEATING EQUIPMENT +100,000 BTU x 15.00 =
GAS PIPING (EA OUTLET) X,, 1.00. _ • 0 0
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 $ ,,V40 0
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT
NOTE: s- NIMUM PERMIT FEE IS $35.00 FEE DUE = $ `/9.0 0
SIGNATURE40WQv__
Spokane County Department of Building tafld Safety
456-3675
West 1303 Broadway Avenue Spokane, WA 99 ( u