1992, 10-26 Permit App: 92009770 Mechanical FixturesLys v-.51, t rnS MECHANICAL PERMIT APPLICATION FORM 9, Z 7 70
V44 2►4 Irformation Worksheet
60 B STREET ADDRESS: /�() � 7 tJ ^'J'OZ54
CITY/STATE/ZIP: ,� 'h21I1 1 122 ft /f6 PARCEL NUMBER:
ISI. _ //)f PHONE NUMBER: 9 36c:g
ADDS SS: //,JC�
OWNER:
MAILING
CONTRACTOR:
(Street)
MAILING ADDRESS: P 6 ,5-70`?
(Street)
42/00 o, (1/.. , W
(/City/State) (Zip)
LICENSE NUMBER: SE --6-Ye'.
PHONE NUMBER: AJ - ,56RE
i2 2 ( Al 2,;0
(City/State) (Zip)
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 PI4,ING (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 PUMP &
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
NOTE:
SIGNATURE` v�
Spokan C = Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
FEE IS $35.00
4(0
x$10.00 =
x 25.00 =
x 10.00 =
x 12.002 =
1J -94i
X
fr-
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 =
Y 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 =
/0 . co
�a.0o
Cao
SUBTOTAL
$
PLUS: PROCESSING FEE
EQUALS: TOTAL PERMIT
FEE DUE
I
r
VOICE RECAP AND DISBURSEMENT VOUCHER
STORE NO. ' Z.,79'
STORE Aka/Ate-
DATE
No. '742376
/0
CUSTOMER'S NAME
SALESCHECK
NUMBER
JOB I.D. NO. OR
WORK ORDER NO.
AOUNT
ALLOCATION OF EXPENSE — FOR INSTALLATION OFFICE USE
DUE
CONTRACTOR
ACCOUNT
NUMBER
DIV.
NO.
ADJUSTMENT
ACCT.
ACCT.
CONTRACTOR
EXPENSE
MEMO
SELLING
yeivIt
/0-.23
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I cerfify that the installations listed above have all been
completed satisfactorily in accordance with the speci
fications furnished me.
(CONTRACTOR'S SIGNATURE)
TOTAL
AMOUNT
TOTALS
OK TO PAY
(AUTHORIZED SIGNATURE)
CHECK NO
14489 (See Bul. 0-187 Part II Supp. 8) REV. 3/91 SEARS FORMS MANAGEMENT
(DATE)
ACCOUNTING COPY
PAYING UNIT NO.
PAYING
UNIT NAME
(If Different)