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1991, 10-30 Permit App: 91007366 Furnace, Piping MECHANICAL PERMIT APPLICATION FORM � Information Worksheet JOB STREET ADDRESS: ` . //c O 6 9ek Qj-7s • CITY/STATE/ZIP: wA 92O( PARCEL NUMBER: 215 . )5O5 j OWNER: f PHONE NUMBER: '92 - V V 7 g MAILING ADDRESS: (Street) - (City/State) (Zip) CONTRACTOR: A&M QUALITY HEATING LICENSE NUMBER: AM,QUAHE19'4N1 E. 1ORSI J aNKAVE. PHONE NUMBER: 928-2100 SPOKANE, WA 99216 MAILING ADDRESS: (Street) • (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT = AMOUNT DUCTWORK SYSTEM •X$10.00 = WOODSTOVE/INSERT r .. x 25.00 _ GAS WATER HEATER x 10.00 = HEATING EQUIPMENT <100,000 BTU _ - _ _ 1 0 x 12.00. + / , O HEATING EQUIPMENT +100,000 BTU - x 15.00 = GAS PIPING (EA OUTLET) f x 1.00 - /, OO 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 m 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 = 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 $ /3,o O PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT 3 �� NOTE: MIN MUM PERMIT / EE IS $35.00 FEE DUE _ $ SIGNATURE _ 1/ Appip,..40- pokane County Department of Building"and Safety West 1303 Broadway Avenue Spokane, WA 99260 ( u ) 456-3675