1993, 06-08 Permit App: 93004473 ACMECHANICAL PERMIT .APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: /V / 4
6%2t 120
CITY/STATE/ZIP:
OWNER: ,6Q1, /
MAILING ADDRESS:
PARCEL NUMBER:
q3 - u473
z�� N
cwt • .
PHONE NUMBER: 9026 ` t3 vZ ,-
(Street) (city/stats) (Zip)
CONTRACTOR: A&M QUALITY HEATING LICENSE NUMBER: Asgswazi alv
E. I ihriNJ)1AN.AVE.
MAILING ADDRESS:
SPOKANE; WA 99216
PHONE NUMBER: 9211.2100_
(Street)
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
OFFUBgR UNITS UNIT
DESCRIPTION
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT cToo,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
HEAT PUMP & AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 15-30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & AIR CONDITIONER +50 TONS
VENTILATING FANS
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
0.
• AMOUNT
•X110.00 •
X 25.00,.
X 10..00 •
X 12.00. •
X 10.00 •
X., 1.00 .
X12.00..
X 20:00 s
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 No
x 15.00 •
SIGNATURE__:NOTE: M PERM T FEE IS $35.00
i3
Spokane County Department of Buildingtand Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
SUBTOTAL
S /Q. OD
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE - $ 3'7,00