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