1991, 08-01 Permit App: 91004666 ACMECHANICAL PERMIT APPLICATION FORM B Z Ll
Information Worksheet --
JOB STREET ADDRESS: Za 0 / 9
CITYISTATEOP: PARCELNUMBER:
OWNER: .7Tohri J�.� n_� r�� PHONENUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: Aire Valley Heating 6 Cooling LICENSENUMBER: AIREVHI1410H
PHONE NUMBER: 924-0018
MAILING ADDRESS: N 521 Ella Rd Spokane WA 99212
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE �L�-rzi„�.�-'
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'. ”
X10.00.
x 50.00 .
x100.00.
X60.00 .
x100.00.
;12.00 ..
x 15.00 .
.., .. ..Pyr..
SUBTOTAL
$
PLUS: PROCESSING FEE
+$ 25.00'
EQUALS: TOTAL PERMIT
FEE DUE
=$ 3 i
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675