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1992, 10-26 Permit App: 92009769 Furnace
JOB STREET ADDRESS: CITY/STATE/ZIP: MECHANICAL PERMIT APPLICATION FORM 9a..Q71Qcf Irformation. Worksheet • �� ,-4 el() (/ 2n.ti,C 3©252 v;1,1_7,( ((h 27?,O PARCEL NUMBER: OWNER: /7#0) -1 -)10.1,1Z4101 -h MAILING ADDRESS: 77c;?/06/ ,1 -G (Street) CONTRACTOR &7/ .v) / Ff_P MAILING ADDRESS: Po % c-517,-/ (Street) ausINNIIIMMENNEENIEMIlmillimmr PHONE NUMBER: 9 ,--)ba/ Q di (City/State) (Zip) LICENSE NUMBER:.- E - 7qv -sG''C_ - PHONE NUMBER: 47/f20- �v v (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH OF UNITS UNIT DESCRIPTION = AMOUNT DUCTWORK SYSTEM WOODSTOVE/INSERT GAS WATER HEATER HEATING EQUIPMENT <100,000 BTU HEATING EQUIPMENT +100,000 BTU GAS PIPING (1 -_4 OUTLETS) GAS PI4ING (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 +1,75OM BTU 0-3 TONS 3-15 TONS _ 15-30 TONS 30-50 TONS _ +50 TONS HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER VENTILATING FANS 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 x$10.00 = x 25.00 = x 10.00 = x 12.00 = x 1 X 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: SIGNATURE FEE IS ,$35.00 v� SUBTOTAL $ //A 4T>, PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = Spok ne ' ,T ty Department of Building and Safety • West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 PAY TO CE RECAP AND DISBURSEMENT VOUCHER STORE NO 47/V79' STORE No. 742378 DATE /0 (CONTRACTOR'S SIGNATURE) OK TO PAY CHECK NO. 14489 (See Bul. 0-187 Part 11 Supp. 8) REV. 3/91 SEARS FORMS MANAGEMENT (AUTHORIZED SIGNATURE) (DATE) ACCOUNTING COPY PAYING UNIT NAME (If Different) ‘MOUNT ALIOCAIION 111- tArcrg E — MEMO SALESCHECK 1 JOB I.D. NO. OR NAMEDUE NO. ACCOUNT DIV. 1 ACCT. ACCT CONTRACTOR EXPENSE SELLING CUSTOMER'S NUMBER WORK ORDER CONTRACTOR NUMBER NO. 1 ADJUSTMENT Zro„,31-2/7/)di 3C6.6/6/13,570 -- 11 Aft, 1/ e / 7207 ai /I _./... 4 1A 0" ... (1--- I certify that the installations listed above in have all been with the speci TOTAL AMOUNT TOTALS completed satisfactorily accordance cg fications furnished me. PAVIMP, I II\IIT NO_ (CONTRACTOR'S SIGNATURE) OK TO PAY CHECK NO. 14489 (See Bul. 0-187 Part 11 Supp. 8) REV. 3/91 SEARS FORMS MANAGEMENT (AUTHORIZED SIGNATURE) (DATE) ACCOUNTING COPY PAYING UNIT NAME (If Different)