1993, 12-09 Permit App 93011792 Heat Pumps
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet 7 3 7%Z
JOB STREET ADDRESS: Z 3
CITY/STATEIZIP: Sn:r �� TIrla-rtj i 42 PARCEL NUMBER:
OWNER: 2 ,,, _PHONE NUMBER: Y, 9 R N
MAILING ADDR S:
(Street) Id4y/9t6te) (Zip)
CONTRACTOR:N g=;r-r-zD 41 eAfc-,O=Q LICENSE NUMBER: QJA
PHONE NUMBER: 6-4
MAILING ADDRESS: )E _5/0Z �1_:Z 2 /j
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NOTE: MINIMUM PERMIT FEE IS $35.00
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 a
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 =
xi 00.00 =
x 50.00 =
X100.00 =
x 12.00 =
x 15.00 =
_
-
II��
_
SUBTOTAL
$
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
$ o
Spokane County Division of Buildings