1993, 04-22 Permit App: 93002821 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM a �J
Informations Worksheet
JOB STREET ADDRESS: �' 5 /d S7"LGr .
CITY/STATE/ZIP: Stb Gfh7 99 / PARCEL NUMBER:
OWNER: (110/a:12-0 /C _APHONE NUMBER: ,9c /g _
MAILING ADDRESS:
(Street) - (City/State) (Zip)
CONTRACTOR: A&M QUALITY HEATING LICENSE NUMBER: pmn 1 391
t1ii 'I" TNCIANA AVE. PHONE NUMBER: 928-2109
• SPOKANE, WA 99216
MAILING ADDRESS:
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION OFUUNIITTS XUNITN = AMOUNT
DUCTWORK SYSTEM •410.00 =
WOODSTOVE/INSERT x 25.00 _
GAS WATER HEATER 7 ,
x 10.00 • / 00
HEATING EQUIPMENT <100,000 BTU _ / X 12.00 me / , 00
HEATING EQUIPMENT +100,000 BTU X 15.00 =
GAS PIPING (EA OUTLET) "04 X 1.00. - a , (20
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) X 12.00,= •
REFRIG 101-500M BTU X 20.00 es
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 = /L',(2r)
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 s
AIR HANDLER >10,000 CFM x 15.00 =
SUBTOTAL $ 3i.UD
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT
NOTE: MI IMM PE' T EE I , $33.00 FEE DUE = $ Gi /, 00
SIGNATURE ___ i -/I &4 Wil/)
Spokane County Department of Buiidin 'and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675