1993, 01-06 Permit App 93000056 Gas DryerJOB STREET
CITY/STATE/;
OWNER
MAILING ADC
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
ADDRESS:_ roc dioza e
LP: SAO/die 1,04 q --'Li 6 PARCEL NUMBER:
PHONE NUMBER:
RFCC• � 1V b
/ (Street) (City/State) (Zip)
CONTRACTOR: r/°'4-s1n�� bps CG LICENSENUMBER: INMrZGs"Q-Q
PHONE NUMBER: 4 - cc. 3.27 33c,:a
MAILING ADDRESS: 26-9!�- t st/;. C r uy%A� i�>s �4 //_
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE G/f c
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 =
cJ L7
/
p,
SUBTOTAL
$
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
Spokane County Division of Buildings
West 1303 Broadwav Avenue Snokane. WA (WRO /-c;n4► 4x;S_ae7F