1992, 11-06 Permit App: 92009823 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
2 mflertna� Worksheet 13�
JOB STREET ADDRESS: 1, ) � 1 E
CITY/STATEMP: SGS P tdtiP �� .���a Co In PARCELNUMBER: "
OWNER:�ACKAkx,2e dy SEC -RAS PHONENUMBER: q26- LC,2'l
MAILING ADDRESS: Y
(Street) (City/State) (zip)
CONTRACTOR: Heat Transfer Inc. LICENSENUMSER: Heatti-1881n
PHONE NUMBER: 328-3400
MAILING ADDRESS: N_ 1008 Ruhv Spokane, WA 99202
(Street) (ChAtate) (Tp)
MECHANICAL WORKSHEET/FEE SCHEDULE
NOTE: MINIMUM PERMIT FEE IS $35.00
NUMBER
OF UNITS
X EACH
UNIT
-AMOUNT
x 10.00 =
x 25.00 =
x10.00=
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
X35.00 =
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 =
X10.00 .
x 50.00 =
X100.00 =
X 50.00 =
X100.00 -
100.00-x12.00 =
X12 -00
x 15.00 =
C
SUBTOTAL
$ .00
PLUS: PROCESSING FEE
+$ 25.00'
EQUALS: TOTAL PERMIT
FEE DUE
_$
SIGNATURE
Spokane un
ty Division of Buildings
West 1303 Rrnadwav Avenues Srinkane WA QQ9RD l6nQ1 d5R_AR7S