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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