1992, 05-07 Permit App: 92003178 Heat PumpMECHANICAL PERMIT APPLICATION FORM
Intoraatiof Worksheet
JOB STREET ADDRESS: ti
S . / / (2 �/�VL-G
CITY/STATE/ZIP: !N%4 f �IPARCEL NUMBER:
OWNER: _/ C�/(n
MAILING ADDRESS:
(Street)
92 3
PHONE NUMBER:
CONTRACTOR:
(City/Stag) (Zip)
A&M QUALITY HEATING LICENSE NUMBER: 4,14quomAcron
E.I2?it'iI ANkAVE.
SPOKANE. WA 99216
MAILING ADDRESS:
PHONE NUMBER: 9211•21An
(Street)
(City/Stats)
(Zip)
IIEC ANICAL WORXSHEET/FEEESUNMTSSCCHHEEDULE•
OF MAT
DESCRIPTION
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
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
0-3 TONS
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
HEAT PUMP &
HEAT PUMP &
HEAT PUMP Q
HEAT PUMP &
HEAT PUMP &
VENTILATING
EVAPORATIVE
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
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
COOLERS
(
• AMOUNT
•x$10.00 -
x 25.00 •
x 10.00 •
x 12.00• -
x 15.00 .
x 1.00 •
X 12.00,:
X 10.00 •
x 25.00..
X 35.00 -
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 is
/.1.1)6
SUBTOTAL
$ /a .00
PLUS: PROCESSING FEE + $ 25.00
NOTE: MINA M E I FEE I $35.00
SIGNATURE___ `�� (
Spokane County Department: of BuildincIrand Safety
West 1303 Broadway Avenue Spokane. WA 99260 (509) 456-3675
EQUALS: TOTAL PERMIT
FEE DUE a. $ 3 % c v