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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