1992, 1030 Permit App 92009561 Wtr Htr & Mech Fixtures,-A-1-CltQ l
MECHANICAL PERMIT APPLICATION FORM
2 Information Worksheet
JOB STREET ADDRESS: 6. /,J 7,
CITY/STA
MAILING
PARCEL NUMBER:
PHONE NUMBER:��ll
(Street) (City/State) (Zip)
CONTRACTOR ?/ ���% /x Pcd_(�� c LICENSE NUMBER: &611 'nllb)/7C) /I Z
PHONE NUMBER `?.36/- Ll`/ IS
MAILING
DESCRIPTION
(Street)
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(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 1,0.00 =
x SO.t)0 =
X100.00 =
x 50.00 =
X100.00 =
x 12.00 =
x 15.00 =
C
SUBTOTAL
$
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_ $
Spokane County Division of Buildings
Wact iinq Rmndwav Avaniia Cnn4ann 1A/A 009Rr1 /FnO1 AFR_QR7r.