1993, 05-26 Permit App: 93003961 Water Heater, PipingMECHANICAL PERMrT APS LICATION FORM
..Information Worksheet
JOB STREET ADDRESS:,���nn
CITY/STATE/ZIP:,-�( 1!
PARCEL NUMBER: 7 � 7L(- &W',�25;'
PHONE NUM
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: a LICENSE NUMBER: �O E00ij ('10(Z L,
PHONE'NUMBER;�`/
MAILING ADDRES
DESCRIPTION
(Street)
(City/State)
'MECHANICAL WORKSHEET/FEE SCHEDULE
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE �T /r7
NUMBER
OF UNITS
X EACH
UNIT
=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 =
x50.b0 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00
SUBTOTAL
$ j. Q
PLUS: PROCESSING FEE
i+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
'36
_ $
Spokane County Division of Buildings
Wdot ria -ut.uw y Av nue Spokane, WA_ 99260 (509) 45,q-3,675