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1992, 05-13 Permit App: 92003340 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM Inforration Worksheet JOB STREET ADDRESS: CITY/STATE/ZIP: d/i �v� li(i/�_ PARCEL NUMBER: OWNER: �� S, ��ig �/�-� S PHONE NUMBER: AILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER IP48 GAS EQUIPMENT +100,000 BTU DUCTWORK) BOILER/REFRIG 1-100M BTU TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) CLOTHES DRYER 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 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = ( 12,, C, C) t �.c0 SUBTOTAL $ 13 00 PLUS: PROCESSING FEE +$ 25.00 EQUALS: TOTAL PERMIT FEE DUE 1=$ M� gj•'CJ Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675