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2006, 05-05 Permit App: 06001697 Insert, Piping . q, D -3I MECHANICAL PERMIT APPLICATION FORM Information Worksheet cA 53 JOB STREET ADDRESS: oS64tt..04 a v7 / /i ' . CITY/STATE/ZIP: ip 997e)3/ PARCEL NUMBER: OWNER: it.C.4 . I / PHONE NUMBER s /v? 41.-o7 �o MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: A&M QUALITY HEATING LICENSE NUMBER: Allay Atm 9 VJ t E. 12 J4I1j�A'�/E• PHONE NUMBER: 9211-2100 SPOKANE, WA 99216 MAILING ADDRESS: (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE BDESCRIPTION OFFUUNNIITTS EAC = AMOUNT DUCTWORK SYSTEM 410.00 = WOODSTOVE/INSERT x 25.00 = GAS WATER HEATER • / • x 10.00 = 10, 00 HEATING EQUIPMENT <100,000 BTU _ _ X 12.00• = HEATING EQUIPMENT +100,000 BTU X 15.00 = GAS PIPING (EA OUTLET) X 1.00 0 a , On REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12.00,E REFRIG 101-500N 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 = /0, 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 $ a2, ,©o PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT NOTE: N iMUM PE; 41 EE S $35.00 FEE DUE = $ 47oo SIGNATURE_._. 0` . . /, A tl.i 1 Spokane County Department of Building_and Safety 09 456-3675 West 1303 Broadway Avenue Spokane, WA 992 1 1