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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