1991, 10-17 Permit App 91006896 FurnaceDESCRIPTION
MECHANICAL PERMIT APPLICATION FORM
Information/�/�_
- W�orrksheet
JOB STREET ADDRESS: S , S0 0 y 2tt-t �' We
CITY/STATE/ZIP: Sio.64.0a.42/; 164 910� PARCEL NUMBER: 05$(' /263
OWNER: PHONE NUMBER: 9a 8- t' 2 «3
MAILING ADDRESS:
CONTRACTOR:
(Street)
A&M QUALITY HEATING
1 ffr&rNoIANA AVE.
• SPOKAW`E; WA 99216
MAILING ADDRESS:
(City/State) (Zip)
LICENSE NUMBER: AMQIIANR1QiN1
PHONE NUMBER: 928-9100
(Street)
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
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
EVAPORATIVE
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
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
= 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 =
P'2 -Od
Z -Ud
NOTE:
SIGNATURE
MC
EE IS $35.00
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
Spokane County Department of Building/ nd Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675