1992, 12-03 Permit App 92010661 BoilerMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: A,� CLA,
CI i C�
CITY/STATE/ZIP: - >CUh rk)A q al PARCELNUMBER: n
OWNER: R CG R Y'OL16- PHONE NUMBER:
MAILING ADDRESS: E, 'I-ga3 (^LkO hd -)MtCerne _ LA q q
(Street) '(City/State) (Zip)
CONTRACTOR: Rnnner Firrnace & Fuel. Tar -LICENSE NUMBER: BANNEFF378NT
CONTACT: RUSS LUNDE PHONE NUMBER: S3S-1711
MAILING ADDRESS: P.O. Box 4346 Spokane, WA. 99202
(Street)
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
NOTE: MINIMUM PERMIT FEE IS $35.00
(zip)
NUMBER
OF UNITS
X EACH
UNIT
=AMOUNT
X 10.00 =
x 25.00 =
X 10.00 =
x 12.00 =
x 15.00 =
X 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
X 60.00 =
X 10.00 =
X 10.00 =
x 50.00 =
X 10.00 =
x 10.00 =
X 10.00 =
X 10.00 =
X 10.00 =
x 50.00 =
X100.00 =
X 50.00 =
X100.00 =
x 12.00 =
x 15.00 =
p,
SUBTOTAL
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
SIGNATURE Q�A-�P .G( u
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675