1990, 09-24 Permit App: 90004689 Reroof- L/6 K -
PARCEL NUMBER:
INFORMATION WORKSHEET
STREET ADDRESS: 97 3 / ,
CITY/STATE/ZIP: ji1 i�l �c P / `W q CI a(
SUBDIVISION:
:BLOCK:. LOT: ZONE: --'-DISTRICT:
•
LOT AREAS_ __,.. -F/A: WIDTH: DEPTH: R/W:
# OF BUILDINGB:-
OWNER:
# OF DWELLINGS: .WATER -DISTRICT
MAILING'ADDRESS:-
CITY/STATE/ZIP:
PHONE: - /5-7
CONTACT: ,d,
aja-gG/
-
7. ML)- X 3
(7-‘,
SETBACKS: - FRONT: LEFT: RIGHT: - REAR:
PERMIT USE:
****************************************************************************
BUILDING INFORMATION
CONTRACTOR LICENSE NUMBER:' - - Ye - 3 7 C? /1-)/
CONTRACTOR: \('0 / �� ! / / PHONE : C1L -/170- t)(3 47(,
MAILING ADDRESS: PO 60K 0 70 7 vieL,642.4uta GL/' 9,`")o n
ARCHITECT/ENGINEER: -.
MAILING ADDRESS:
NEW: REMODEL:__
OCCUPANT LOAD:
DWELL UNITS:
BUILDING DIMENSIONS:
REQUIRED PARKING:
X
PHONE : ,
DITION: CHANGE OF USE:
BUILDING HGT: STORIES:
(WIDTH X DEPTH) SQ. FT.:
HANDICAP: SEWER (Y/N): HYDRANT:
Pay to:
1 a. CONTRACTOR'S RECEIPT
INSTALLATION INVOICE - 32255;
N
E
DIV.
WORK
ORDER #
CUSTOMER'S
NAME
PERMIT
NO.
DATE
COMPL
INSTALLER
CHARGES
A.
2
(rer«cc.
Store
Date
3
4
5
6
7
9
10
11
12
TOTALS
(FOR USE BY CASHIER)
CHECK #
y
AMOUNT
cc -7
All supporting detail must be attached.
I certify that the installations listed above have all
been completed satisfactorily in accordance with the
specifications furnished me.
(DATE)
(CONTRACTOR'S SIGNATURE)
15400 REV. 10-69 (INSTRUCTIONS FOR CONTRACTOR PRINTED ON 3RD COPY)
Date paid:
CONTRACTOR'S INSTRUCTIONS
FOR FILLING OUT INSTALLATION INVOICE
1. In Section "A", fill in business name and mailing address in upper left-
hand box.
2. a. INVOICE FOR LABOR ONLY. Using the information on the
GOTC, complete Section "A" indicating the division, work order
number, customer's name, date of completion and charges for labor
performed.
b. INVOICE FOR MATERIAL AND LABOR.
A purchase order will be given with the GOTC for any material
you are to furnish on a job, such as: a special plenum for an
add-on air conditioner, pipe for water softeners, etc. When sub-
mitting your invoice, follow Step 2a and list your labor charges
only. On the next line, in the column titled "Work Order #", put
the letters "P.O" and the purchase order number. Indicate the
customer's name and the charges for the material supplied.
c. If you work for more than one Sears store, submit a separate
invoice for each store.
3. Total the amount of the invoice & enter opposite word `Totals'. Do
Not Enter Anything Opposite Words `Check #'.
4. Remove the #4 copy and retain for your records. This will allow you
to have a copy of all bills submitted but not paid. Attach all GOTC's
to support the entries, sign and date the invoice at the bottom of
Section "A" where indicated.
5. Submit invoice to the Installation Office to process for payment