1992, 09-23 Permit App: 92007996 Heating EquipmentJOB STREET
MECHANICAL PERMIT APPLICATION FORM
Informaiibn Worksheet
33
CITY/STATE/ZIP: .S? &n a � Q�PARCEL NUMBER:
OWNER: PHONE NUMBER: I 7 --2 7,32
MAILING ADDRESS: 67
(Street) (City/State) (Zip)
CONTRACTOR: AIRE VALLEY HEATING & Coolina LICENSE NUMBER: ATRF.VTiT141 oR
PHONE NUMBER: 924-0018
MAILING ADDRESS. N. 521 Ella Rd. Spokane, WA 99212
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE gjZ�� g"
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 =
x 50.00 =
X100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x15.00 =
SUBTOTAL
$ -2
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ pv
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675