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1992, 10-09 Permit App: 92008706 Mechanical Fixtures 1575 • MECHANICAL PERMIT APPLICATION FORM Information Worksheet ‘ qi`1 it' �a JOB STREET ADDRESS: t * f7d y de-e_�i t CITY/STATE/ZIP: „� , 11A 99g /lv PARCEL NUMBER: 1 „(1 5 , cQ / 1'. � 7 , OWNER: (% / /� PHONE NUMBER: J� 7- D5 / 3 MAILING ADDRESS: -� (Street) (City/State) (Zip) CONTRACTOR: A&M QUALITY HEATING LICENSE NUMBER: Ah1QI1AHR149N1 E117iiriNI4ANA AvE. PHONE NUMBER: q2B-2100 SPOKAr E, WA 99216 MAILING ADDRESS: (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION OF UNITS xUNITH = AMOUNT DUCTWORK SYSTEM •x$10.00 = WOODSTOVE/INSERT x 25.00 = GAS WATER HEATER �� HEATING EQUIPMENT <100,000 BTU / I X 12.00. = / 'A . 0 Q HEATING EQUIPMENT +100,000 BTU x 15.00 = GAS PIPING (EA OUTLET) :.I x 1.00 = , , pp 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 $ ,21{,OD PLUS: PROCESSING FEE + $ 25.00 EQUALS : TOTAL PERMIT NOTE: MINIMUM� PERMIT FEE IS $35. 00 FEE DUE = $ '-/' po SIGNATURE ___-- - �_ Spokane County Department of Buildinqq�and-)76-°'4 - Safettyy West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675