1994, 01-05 Permit App 94000118 Water HeaterSS1 g3 . otP 94,
Lls 317
JOB STREET ADDP
11AMECHANICAL PERMIT APPLICATION FORM
' Information Worksheet
CITY/STATEOP• & ,e o,
OWNER: °
MAILING
NUMBER:
PHONE NUMBER:
q�- -I (Y
(Street) // (Zip)
CONTRACTOR:A1nw-sr C�� LICENSE NUMBER:/Iia ,) Zz 74 L
% PHONE NUMBER:
MAILING ADDRESS: E � �l
(Street) '(City/State) I/ (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NJTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE -J�
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 e
x 35.00 =
x 60.00 a
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00
x 10.00 =
X 10.00 a
x 10.00
x 5600
X100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
d
_
_
_�
_
_ i
_
_
SUBTOTAL_
$
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 35.
okane County Division of Buildings