1993, 03-30 Permit App: 93001939 Stove, PipingJOB STREET ADDR
MECHANICAL PERMIT APPLICATION FORM
3
Information Worksheet
CITY/STATE/ZIP: �Aal�a-e- �a �%��2'
OWNER:
MAILING ADDRESS: f 3 3_ly IjY
CONTRACTOR:
MAILING ADDRESS:
(Street)
(Street)
PARCEL NUMBER:
PHONE NUMBER: c)'� 6 -/5 / �-
9 ty2 > z
(City/State)
LICENSE NUMBER:
PHONE NUMBER:
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
UNLISTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(Zip)
(zip)
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 =
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