1992, 07-27 Permit App 92005721 Wtr HtrDESCRIPTION
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (EA OUTLET)
REFRIG 1-100M BTU (NOT A/C OR .HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
0-3 TONS
3-15 TONS _
15-30 TONS _
30-50 TONS _
+50 TONS
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE) _
UNLISTED GAS APPLIANCE <400,000 BTU
UNLISTED GAS APPLIANCE >400,000 BTU_
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS:
CITY/STATE/ZIP: -f'_/: 4)4 a I,QI,i PARCEL NUMBER:
OWNER: CviA4 / 1 f '✓ * ✓ - l/uivq.�-' PHONE NUMBER: / ; 0 r 75 l
MAILING ADDRESS:
(City/State) (Zip)
CONTRACTOR:
(Street)
A&M QUALITY HEATING LICENSE NUMBER: A O)JAHR193N1
E 1 OIANA A'VE.
SPOKANE; WA 99216
MAILING ADDRESS:
PHONE NUMBER: 928-2100
(Street)
(City/State)
(Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
1
NOTE: MI IMUM PERMIT FEE IS $35.00
SIGNATURE ; Q�
= AMOUNT
X$10.00 =
x 25.00 =
x 10..00 '_
X 12.00. _
x 15.00 =
X„ 1.00..=
x 12.00,=
x 20.00 =
x 25.00 ._
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
X 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
X 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
PLUS: PROCESSING FEE
/n,60
1,Qi'
EQUALS: TOTAL PERMIT
FEE DUE
$ /,00
+ $ 25.00
= $ 36 .00
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675