1991, 11-14 Permit App 91007836 Htg EquipDESCRIPTION
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JOB STREET ADDRESS:
CITY/STATE/ZIP:
OWNER: 1-Ai
MAILING ADDRESS:
C\
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
�. /7ij//
E. /74/65
(Street)
CONTRACTOR: A&M QUALITY HEATING
1 f1INDIANA AVE.
MAILING ADDRESS:
SPOKA iE, WA 99216
9 ? /6 PARCEL NUMBER:
PHONE NUMBER: ° 84- SO 7/
(City/State) (Zip)
LICENSE NUMBER: AMOJJAHF.1QMN1
PHONE NUMBER: 928-2100
(Street)
(City/State)
(Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
p�NES X EICH
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
HEAT PUMP & AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS _
HEAT PUMP & AIR CONDITIONER 15-30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS _
HEAT PUMP & AIR CONDITIONER +50 TONS
VENTILATING 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
NOTE:
SIGNATURE:
= 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 =
a D
„Q • 0 o
SUBTOTAL $ f /, o
PLUS: PROCESSING FEE + $ 25.0
EQUALS: TOTAL PERMIT
FEE DUE = $ 39. C
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675