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