1992, 12-23 Permit App 92011145 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
information
JOB STREET ADDRESS:
9-1-111(6
7tB�
C ITY/STATE/ZI P B -,,� I I ),n PA&EL NUMBER:
OWNER: 2 E:Y6 I' J7 PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) M
_ A 0(zti-pZ)
CONTRACTOR:LICENSE NUMBER: k -70a Ll1(-1
'I q PHONE NUMBER: 4�W- (-/
MAILING ADDRESS:
(Street)
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE-4,-�-�"
(zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00
x 25.00
x 10.00
x 12.00
x 15.00
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x'bo =
50.
X1 00.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
1/0
=$ -/ -t , (�
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 09260 (509) 456-3675