1991, 10-23 Permit App: 91007105 Furnace, PipingJOB STREET
OWNER:
MAILING
MECHANICAL PERMIT APPLICATION FORM
:q
PARCEL NUMBER: V J !�) - v t I�
PHONE NUMBER: 1577'i'- 5"Oq B
(Street),/ / (City/State) (Zip)
CONTRACTOR: -6 R�t`%ni� •!�'®T A�� LICENSE NUMBER: ��lrH/il%�/SOH7 �f
PHONE NUMBER: �/S 3 3� /
MAILING ADDRESS: /.2 2
�i0 (illy �i1
(Street) (iry/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
BOILER/REFRIG 1-100M BTU
BTU
BOILER/REFRIG
3-15 TONS
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATUR
NUMBER
OF UNITS
XEACH
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 60.00 =
x100.00 -
x 50.00 =
X100.00 =
x 12.00 =
x 15.00 =
.2 =o
SUBTOTAL
$
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
$
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675