HomeMy WebLinkAbout1994, 07-05 Permit App: 94006210 FurnaceMECHANICAL PERMIT APPLICATION FORM / K
Informatian' Worksheet y5r 3 2 g I
JOB STREET ADDRESS:
CITY/STATE/ZIP-�A %y 0 % PARCEL NUMBER:
OWNER: -L 3 PHONE NUMBER: �,° - .3
MAILING ADDRESS:
(Street) (City/State) / /� (Zip)
CONTRACTOR: LICENSE NUMBER:�%V C o� /A
i PHONE NUMBER: 3-J,/ 41q ,1
MAILING ADDRESS:
(Street)
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE_�i �'LE�.✓
(Zip)
NUMBER
OF UNITS
X. EACH
UNIT
=AMOUNT
x 10.00 =
x 25.00 =
x 10.00 -
x12.00 =
x 15.00 -
x 1.00 =
x 12.00 -
x 20.00 -
x 25.00 -
x 35.00 -
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
X100.00 =
x 50.00 =
X100.00 =
x 12.00 =
x 15.00 =
- v
/ �-
_
SUBTOTAL
a 1, D
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= a�%,G
Spokane County Division of Buildings
West 131 '-way Avenue Spokane, WA 99260 (509) 456-3675