1992, 08-07 Permit App: 92006218 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM C a — (0 a
/ Information Worksheet t�c�
JOB STREET ADDRESS: (� �� -nxZL�f�
CITY/STATE/ZIP:��('��. I,�-�AI�2 PARCEL NUMBER:
OWNER: i-�iZ =b PHONE NUMBER��D�Z-D%rY%
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER: lUO2C O /)19/ 7d/�
MAILING ADDRESS:
PHONE NUM
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
.
Ott";.:.;;:;..:.;:::::: ..:. �::::::::::::
GAS WATER HEATER
GAS E�11Ptu1>*NTf 00►t0' U {1IGklitrS
GAS EQUIPMENT +100,000 BTU DUCTWORK)
M.
U
t
A p M. N.G. �A. Q <><>'><>�«>`;<
BOILER/REFRIG 1-100M BTU
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE�]�z_1� l
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x10.00
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 =
x5'bo =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
�1
'
SUBTOTAL
$ �3, bb
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