1993, 02-05 Permit App: 93000652 MechanicalJOB STREET ADDT
CITY/STATE/ZIP:4-
OWNER:
MAILING AD KESS:
MECHANICAL PERMIT APPLICATION FORM cJ2.
` Information Worksheet
/ f
PARCEL NUMBER:---_.- / -
�l1 �lSYI _ PHONE NUMBER: , �� - 111
(Street) (City/State)
CONTRACTOR: � LICENSE NUMBER:
PHONENUMBER:__
MAILING ADDRESS:
(Street)
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
NOTE: MINIMUM PERMIT FEE IS $35.00
e SIGNATURE�1014j
(zip)
(zip)
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 3.5.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.0} _
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 T
(�� �
$ "( VVb
Spokane County Division of Buildings
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