1992, 01-24 Permit App 92000416 Wtr Htr Htg EquipLW°.
•
DESCRIPTION
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
AIR CONDITIONER 0-3 TONS
AIR CONDITIONER 3-15 TONS
AIR CONDITIONER 15-30 TONS _
AIR CONDITIONER 30-50 TONS _
AIR CONDITIONER +50 TONS _
FANS
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
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 orksheet,
JOB STREET ADDR,SS: �� - (/(�� 6 - �./Jhl-t�
CITY/STATE/ZI':_
. f
OWNER:
MAILING
DRESS:
CONTRACTOR:
PARCEL NUMBEt:
PHONE NUMBER:
(Street) (City/State) (Zip)
A&M QUALITY HEATING LICENSE NUMBER: AKWAIMA41N1
E 1 Pr&TNT)IANA AVE.
SPOKANE, WA 99216
MAILING ADDRESS:
PHONE NUMBER: 928-2100
(Street)
(City/State)
(Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
NOTE:
SIGNATURE
PERMI EE IS $35.00
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
= AMOUNT
�0 o
[-Q-1C
..Or)
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
Lokane County Department of Building_sand Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675
= $ _ OD