1992, 08-26 Permit App: 92006871 Mechanical Fixtures-m I ` L__\
2 L�N MECHANICAL PERMIT APPLICATION FORM K AS- H' i Is
Information WorksheetL`�� 13
pB STREET ADDRESS:
CITY/STATE/ZIP: S n�y �G �al � PARCEL NUMBER:
OWNER: C rj�u r cc / PHONE NUMBER: 533 0,90" 3
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: MARTIN SHEET METAL INC LICENSE NUMBER: MA RT IS M170KW
PHONE NUMBER: 924-8088 / FAX 924-1688
MAILING ADDRESS: BLDG 103 SPOKANE INDUSTRIAL PARK SPOKANE, WA 99216-1609
(Street) (City/State) (Tp)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATUR
NUMBER
X EACH
OF UNITS
UNIT
=AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
Q
x 12.00 =
'�
x 15.00 =
x 1.00 =
t
x 12.00 =
x 20.00 =
x 35.00 =
x 60.00 _
x i2 00
Y 20.00 =
l 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
=$ S�
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675