1993, 04-09 Permit App: 93002344 Mechanical Fixtures - 313- .33914
MECHANICAL PERMIT APPLICATION FORM -5 11
Information Worksheet "
JOB STREET ADDRESS: /4q/5- /6�'``�
CITY/STATE/ZIP: SA 99'3 7 PARCEL NUMBER: G �j r/ ? /
OWNER: J t7��C.„."..1 / PHONE NUMBER: / b — /3 3 S�
MAILING ADDRESS:
, (Street) (City/Stats) (Zip)
CONTRACTOR: A&M QUALITY HEATING LICENSE NUMBER: ayQuAHR191N 1
t 1 girreNCOANKAVE. 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 1410.00 =
WOODSTOVE/INSERT X 25.00 =
GAS WATER HEATER X 10.00 =
HEATING EQUIPMENT <100,000 BTU _ / X 12.00. = /n1, O()
HEATING EQUIPMENT +100,000 BTU X 15.00 =
GAS PIPING (EA OUTLET) ;L x, 1.00 = .?,O G
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 =
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 $ 14, oo
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT
NOTE: MINIM ERMIT ' '`�FEE IS $35.00 FEE DUE = $ 39, o0
SIGNATURE___ C-4_ y"
41''x'" ' � d Safe
ty
Spokane County Department of BuiIdtn an
West 1303 Broadway Avenue Spokane, WA 99260 �5 9► 456-3675