1992, 12-04 Permit App 92010648 WoodstoveMECHANICAL PERMIT APPLICATION FORM
Information Worksheet _Tn't)
JOB STREET ADDRESS: OC
CITY/STAT IP> � q PARCEL NUMBER:
OWNER: PHONE NUMBER: ,o-
MAILING ADDRESS.
(Street)
(City/State)
= AMOUNT
(LP)
F'
CONTRACTOR: ! Cr�ND' J CE6Jfr'C
LICENSE NUMBER:
�4ICOGSCI%-3�u
PHONE NUMBER:
U -0g) gu!o-3'q
I)
MAILING ADDRESS: L CI31 D S Isar LSP
S ti rrA e-
1-Jq
c�
(Street)
(City/State)
(LP)
MECHANICAL k.:'ORKSHEETIFEE SCHEDULE
NOTE: MINIMUM PERMIT FEE IS $35.00
NUMBER
OF UNITS
X EACH
UNI ;
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 _'
x 1.00 =
x 12.00
X20.00 ----
X25.00" 20 00 X25 00
x 35.00-'
x6000 =°•
x 12.00
x2000 ?
x 25.00. =(4
x 35.00'=', -
x 60.00"z-'-
0.00"_`_x 10.00
x
x10.00
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 =
i:..
.f , -x
'SUBTOTAL
$ 02
PLUS: PROCESSING FEE
+s 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ 5-0,w
_D.CXR
SIGNATURE _.
Spokane County Division of Buildings