1992, 07-15 Permit App: 92005303 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS:
CITY/STATE/ZIP: � /-' 99 /6 PARCEL NUMBER:
OWNER: 67011 6 -A1-2 PHONE NUMBER: 9, g -566,
MAILING ADDRESS: (Street) (City/State) (Zip)
CONTRACTOR: A&M QUALITY HEATING LICENSE NUMBER: AMopAHR191N1
t 1 fr(rfN(?IANA AVE. PHONE NUMBER: 929-2100
SPOKANE, WA 99216
•
MAILING ADDRESS: (Street) • (City/Stag) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM .x$10.00 =
WOODSTOVE/INSERT x 25.00 =
GAS WATER HEATER • / X 10.00 = (.Q, O:O
HEATING EQUIPMENT <100,000 BTU _ _ _ _ _ I x 12.00 = i, C Q
HEATING EQUIPMENT +100,000 BTU x 15.00 =
GAS PIPING (EA OUTLET) 3 x 1.00 = : . O O
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 =
X 10.00 =
RANGE x 10.00 =
GAS LOG MISCELLANEOUS (NOT COVERED ELSEWHERE) X 10.00 =10.00 =
UNLISTED GAS APPLIANCE <400,000 BTU_ _ _ x x50.00 =
UNLISTED GAS APPLIANCE >400,000 BTU_ _ _ x 50.00 =
USED APPLIANCE <400,000 BTU x150.00 =
USED APPLIANCE >400,000 BTU 12.00 =
AIR HANDLER <10,000 CFM x x 1 .00 =
AIR HANDLER >10,000 CFM
SUBTOTAL $ S: 0 o
PLUS: PROCESSING FEE + $ 25.00
EQUALS : TOTAL PERMIT
NOTE: I M PE T F E I $35. 00
FEE DUE = SSD,UO
SIGNATURE _
okane County Department of Buiiding rand Safety
West 13�3 Broadway
S Avenue Spokane, WA 99260 (509) 456-3675