1993, 05-17 Permit App: 93003562 AC MECHANICAL MINN APPLICATION FORM c.,-kc
Information Worksheet
JOB STREET ADDRESS: 1/00 7 /
CITY/STATE/ZIP: :.clAI Q9,9 'a PARCEL NUMBER: I7')
OWNER: `r ,C
A/A - A-t11 PHONE NUMBER: q17/ - 9 77S
MAILING ADDRES'
(Street) (City/State) (Zip)
CONTRACTOR: AdiM QUALITY HEATING LICENSE NUMBER: AMQIIAHR199N1
1' rinN_D1ANA.AVE. PHONE NUMBER: 928-2100
SPOKANE, WA 99216
MAILING ADDRESS:
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION OFUUNITS XUNITH = AMOUNT
DUCTWORK SYSTEM •X$10.00 =
WOODSTOVE/INSERT x 25.00 =
GAS WATER HEATER x 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 =
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) X 12.00, =
REFRIG 101-500M 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 = /0,00
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 =
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 $ / 2 o O
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT^
NOTE: MINIMU PE IT FEE IS $35.00 FEE DUE = $ 37 00
SIGNATURE
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Spokane County Department of Building O
g and Safety 456-3675
West 1026 Broadway Avenue Spokane, WA 99 1