1992, 01-04 Permit App: 93000003 Furnace�5000003
Sy
M C"ICAL PERMIT APPLICATION FORM
Information Worksheet Rid
JOB STREET ADDRESS: �I �3U3
p��S^. rJ 151
CITY/STATE/ZIP: PARCEL NUMBER: y_Sa G,S �o
OWNER: (� 1i a.nn. J, �v N� 5 PHONE NUMBER: q2,42-025:7
MAILING ADDRESS: l , 13SZ� ��-= ��Ooi�� -�- Wa.
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS: 'z 0,07
(Street)
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
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
_ $
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675