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1992, 03-17 Permit App: 92001623 Pipingr MECHANICAL PERMIT APPLICATION FORM GI a - I ('0 Information Worksheet©O' JOB STREET ADDRESS:' -' Z- Z /ef1"y o.✓o �r CITY/STATE/ZIP: PARCEL NUMBER: OWNER: 6' c,6pgeo PHONE NUMBER: '9Z 4 ?/ S I MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: Banner Furnace & Fuel, 1nc.LICENSE NUMBER: BANNEFF378NT CONTACT: RUSS LUNDE PHONE NUMBER: 535-1711 MAILING ADDRESS: P.O. Box 4346 Spokane, WA. 99202 (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE //fto "'Vr err +d • - /-f- ! s W' /r.w" NC /jre 10 49 0 .f 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 = _ _ SUBTOTAL $ PLUS: PROCESSING FEE +$ 25.00 EQUALS: TOTAL PERMIT FEE DUE 1=$ 3 X a Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675