1992, 08-14 Permit App: 92006437 ACJOB STREET ADDRESS:
CITY/STATE/ZIP:
MECHANICAL PERMIT APPLICATION FORM
62437
7,2 ,A42,,,,144,A 1 .qqe
Ir. formation Worksheet
J% 4eJa, L PARCEL
OWNER: L"""' C)
MAILING ADDRESS: ,4,-7;2c;
NUMBER:
PHONE NUMBER: 9,v- oZ
6..AWA 9903
(City/State) (Zip)
r
LICENSE NUMBER:SC( -7�'s/f -3%,2i)7
PHONE NUMBER: ®
p,, (( 99
/(City/State) (Zip)
St et)
CONTRACTOR: `lU ti it
12/4146/10_1971
MAILING ADDRESS: t Q / "7t0,7
(Street)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT
=AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 --4 OUTLETS)
GAS PIRING (5 OR MORE. EACH:)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
-HEAT----W4 &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
0-3 TONS _
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)
UNLISTED GAS APPLIANCE <400,000 BTU_ _
UNLISTED GAS APPLIANCE >400,000 BTU _
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
1
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x .4-r&8-
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 =
NOTE:
SIGNATUR
IT
FEE
IS $3 .00
SUBTOTAL
•cc
PLUS: PROCESSING FEE
+ S 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $7 °
Sp o -ne Aunty Department of Building and Safety
West 130 Broadway Spokane, S okane, WA 99260 (509) 456-3675
INVOICE RECAP AND DISBURSEMENT VOUCHER
STORE NO 110 '79
STORE
DATE
CUSTOMER'S NAME
SALESCHECK
NUMBER
JOB I.D. NO. OR
WORK ORDER NO,
AMOUNT
DUE
CONTRACTOR
No. 773243
110
ALLOCATION OF EXPENSE
FOR INSTA
ATION OFFICE USE
ACCOUNT DIV.
NUMBER NO,
ADJUSTMENT
ACCT.
1
a AI _
11
0
1
Cac
I certify that the ins allations listed above have all been
completed satisfactorily in accordance with the speci
fications furnished me.
(CONTRACTOR'S SIGNATURE)
TOTAL
AMOUNT
OK TO PAY
CHECK NO.
14489 (See Bul. 0-187 Part 11 Supra. 8) REV. 3/91 SEARS FORMS MANAGEMENT
1
A
CONTRACTOR
EXPENSE
MEMO
SELLING
TOTALS
(AUTHORIZED SIGNATURE)
(DATE)
ACCOUNTING COPY
PAYING UNIT N
PAYING
UNIT NAME
(If Different)