1993, 10-05 Permit Application: 93009342 Gas Piping93 -q.3 q2,
MECHANICAL PERMIT APPLICATION FORM
1 Information Worksheet
JOB STREET ADDRESS: q 9 ZI S. 1la eS
CITY /STATE/ZIP: -SS -, 1. WR 4' 9 10 PARCEL NUMBER:
OWNER: nAA -1b PHONE NUMBER: OlZg - 2k'ZcS
MAILING ADDRESS:
(Street) (City /State) (Zip)
CONTRACTOR: G 4 if Jr ij C F�.I f Fy2 LICENSE NUMBER: F4 I C,0 6 G 1 %3 L:� u
PHONE NUMBER: (_7Cct) 0'-)/' -'`7 11
MAILING ADDRESS: =t P_ 2Cer
(Street) (City /State) (Zip)
MECHANICAL WORKSHEET /FEE SCHEDULE
DESCRIPTION
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
=AMOUNT
x 10.00 =
X 25.0 =
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
X100.00 =
x 50.00 =
X100.00 =
x 12.00 =
x 15.00 =
1
�f-
r
I o
SUBTOTAL
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
Spokane County Division of Buildings
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SITE ADDRESS:
S 4321 BATES RD
PROJECT NUMBER:
93009342 PERMIT TYPES:
ME
`
PERMIT USE:
GAS LOGt 1 PIPING
DESCRIPTION
INSPECTOR
DATE
RESULT
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GAS PIPING
AMAN9 MORRIS
10 /07wwr
10/{37/93
APPROVED
FINAL
WILLIAM DIXON
10/11/93
APPROVED