1991, 07-16 Permit App: 91004254 Furnace, PipingMECHANICAL WORKSHEET/FEE SCHEDULE
NOTE: MINIMUM PERMIT FEE IS $35.00
NUMBER
OF UNITS
MECHANICAL PERO- APPLICATION FORM
=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 =
Information Worksheet
JOB STREET ADDRESS:
S-161E�pj1 y za
CITY/STATE/ZIP:
PARCEL NUMBER:
a
OWNER: ' -n H N
CAg�it ^j 4E r(
PHONE NUMBER: J- .T9 2-Y
MAILING ADDRESS:
(Street)
(City/State)
(Zip)
CONTRACTOR: C3eq-&-f"
moi-- F -c -
LICENSE NUMBER:
PHONE NUMBER:
•�� % C
MAILING ADDRESS:
�O
1 O is Ox
-5l00 k -".,`i
Q f 2 �-
(Street)
(City/State)
(Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
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 =
1.2"00
a
SUBTOTAL
$ ,3, o0
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ 31 , Oa
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675