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1993, 03-01 Permit App: 93001121 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDR CITY/STATE/ZI P: -P� v OWNER: MAILING ADDRESS: CONTRACTOR: MAILING ADDRESS: (Street) PARCEL NUMBER:_ PHONE NUMBER:,�,-1 c -L (City/State) LICENSE NUMBER: PHONE NUMBER: (, %� (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 = 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 1,0.00 = x50.0 X100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = , 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