1993, 05-17 Permit App: 93003570 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: /1441-itLI. C �LGZG.�1c D
CITY/STATE/ZIP: Iktezdet-z"17_ ' 99,a37 PARCEL NUMBER: 4574/ ' X6:17
OWNERS Y w PHONE NUMRURg 9/71s 2/
MAILING ADDRESS:
CONTRACTOR:
(Strs.t) - (City/Stats)
AdeM QUALITY HEATING LICENSE NUMBER: AligumasAvi
E. 127iNIANA-AVE. PHONE NUMBER: 24.,2402
SPOKANE; WA 99216
MAILING ADDRESS:
(Street)
KECHANICAL
DESCRIPTION
(Zip)
(City/Stag)
WORKSHEET/PEE SCHSDUL*
O UNITS Ktaili
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 ETU
GAS PIPING (EA OUTLET)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP A
HEAT PUMP &
HEAT PUMP &
HEAT PUMP 4
HEAT PUMP &
VENTILATING
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
EVAPORATIVE COOLERS
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
(Zip)
. AMOUNT
•x10.00 -
x 25.00
x 10..00 -
x 12.00.0
it
2.00.-
x 15.00 -
x. , 1.00. ,.
x 12.00,a
x 20.00 0
x 25.00
x 35.00•
x 60.00 •
x 12.00 -
x 20.00 -
x 25.00 -
x 35.00 -
x 60.00 -
x10.00 -
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 -
/, QO
/;L,Un
NOTE: MINIMUM PERMIT E IS $35.00
SIGNATURE �� Spokane Count Department of Buildin Land Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
SUBTOTAL
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
5 50,00