1992, 06-09 Permit App 92004158 Mechanical Fixtures y `J�
MECI1ANICAL f a OUT APPLICATION FORM
�I/nformation Worksheet
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JOB STREET ADDRESS: //9 . /3 /'T /e6
CITY/STATE/ZIP: , 6)/+ l 9a16.PARCEL NUMBER:
OWNER: k:4644,6Q PHONE NUMBER: /D /
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: A&M QUALITY HEATING LICENSE NUMBER: AMOJJAHR193141
E12 'INDANA A'JE. PHONE NUMBER: 928-2100
SPOKANi , 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 X 25.00 =
GAS WATER HEATER X 10.00 = /Q, QO
HEATING EQUIPMENT <100,000 BTU / x 12.00. • /o( , G
HEATING EQUIPMENT +100,000 BTU x 15.00 =
GAS PIPING (EA OUTLET) x 1.00 - C
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 $ 0 0
PLUS: PROCESSING FEE + $ 25.00
EQUALS : TOTAL PERMIT
NOTE: I M P EE IS $35. 00 FEE DUE = $ 1 00
SIGNATURE
Spokane County Department of Building"and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675