1992, 08-19 Permit App: 92006617 Mechanical FixturesV A Le/
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MECHANICAL PERMIT APPLLCATION FORM
5S Information Works haot
JOB STREET ADDRESS: C /149423
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CITY/STATE/ZIP: IV A 99v 6 PARCEL NUMBER:
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OWNER: I
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PHONE NUMBER;
MAILING ADDRESS:
(Street)
CONTRACTOR:
•
(City/State) (Zip)
A&M QUALITY HEATING LICENSE NUMBER: wyqNUAGAV1
rloyentANKAvE.
SPOKANE; WA 99216
MAILING ADDRESS:
PHONE NUMBER: 924-2104
(Street)
MECHANICAL
DESCRIPTION
(City/Stag) (Zip)
WORKSHBAT/FEESCCHHEEDULE
OF ESUNIT8 xc:11Ig�
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000
HEATING EQUIPMENT +100,000
GAS PIPING (EA OUTLET)
BTU
BTU
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-5001 BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
VENTILATING FANS
EVAPORATIVE COOLERS
0-3 TONS
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)_
UNLISTED GAS APPLIANCE <400,000 BTU
UNLISTED GAS APPLIANCE >400,000 BTU_
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
011111,
• AMOUNT
•x$10.00 -
X 25.00 •
X 10.00 •
X 12.00. •�
X 15.00 .
X., 1.00 •
x 12.00,:
x 20:00 •
X 25.00 ..
X 35.00 i
X 60.00 .
x 12.00 -
X 20.00 -
X 25.00 -
X 35.00 -
X 60.00 •
X 10.00 -
x 10.00 .
X 50.00 -
x 10.00 -
X 10.00 -
X 10.00 -
x 10.00 •
X 10.00 •
x 50.00 -
x100.00 -
x 50.00 •
x100.00 -
x 12.00 •
x 15.00 -
Irl ,CSO
fQ0
.O0
NOTE: M NIMUM PERM 'FEE IST.00
5.00
SIGNATUktE; %T 4
SUBTOTAL
S Q. oa
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=sI9oo
Spokane Iounty Department of Buildin "and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675