1993, 02-02 Permit App: 93000547 Mechanical Fixtures�C ✓3� GP�� �'\ MECH NICAL PERMIT APPLICATION FORM
Information Worksheet
w JOB STREET ADDRESS:
CITY/STATE/ZIP: d &44,4-. if v PARCEL BER:
OWNER: &g l- nu ' la O PHONE NUMBER:
MAILING ADDRESS:
(Street)
(City/State)
CONTRACTOR: AIRE VALLEY HEATING & coolinct LICENSE NUMBER: AIREVHI1410H
PHONE NUMBER: 924-0018 .
(zip)
MAILING ADDRESS: N 521 Ella Rd Spokane, WA 99212
(Street) - . . (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
=AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x12.00 =
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 =
0
/�100
2 �--
SUBTOTAL
$
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675