1990, 08-23 Permit App: 90004136 Heat PumpMECHANICAL PERMIT APPLICATION FORM T- f,;2 &fyLQ.
InfoatiQn- grksheet _- - a
dzi
JOB STREET ADDRESS): 0,7/ 7 . i4, i j� .� LS 6 /
.CITY/STATE ZIP: leA, 2AC A�Q , /4 . #N7PARCEL NUMBER: ?a- 5 6z7 -B -6---7a S
`OWNER:/,/it-ire
�f-Ia�p,- PHONE NUMBER: ' 7� /4 -7
. . . \ /
INC ADD S: 4 011ie 7/ll .(�// l ./.4.4_449,4 Ji L 99d 37
(Stre/(City/Stat (Zip)'
P LICENSE NUMBER -g_ ;--47,42,
S� 3E57dn/T-.
T 9� l�xz�
PHONE NUMB-cag-//%Q S/,‘.
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"MAILING ADDRESS:`.
(Street) (City/Stat e) (Zip)
E 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 PIING (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
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
VENTILATING FANS
0-3 TbNS
3-15 TONS
15-30 IONS
30-50 TONS
+50 TONS.
EVAPORATIVE COOLERS
TYPE I HOOD.(PER.12' OR 12'
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
PIN. OF HOOD)
MISCELLANEOUS (NOT. COVERED. ELSEWHERE)
UNLISTED"GAS..APPLIANCE400.,000YBTU_
UNLISTED'%GAS.=APPLIANCE >400;000 BTU
_USED.APPLIANCE:<400000..BTU
USED.APPLIANCE->400;0004BTU
AIR- HANDLEk:210 '000` CFMY `^ -
AIR HANDLER ->10,000 -.CFM. -.
/
x$10.00 =
x 25.00
x 10.00
x 12.00
x 15.09
x - .OYO
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 =
70
NOTE: ,MAIN%MUM PE PT FEE„IS $35.00 n
Spokane County Department -of Building and -Safe
West 1303 Broadway Avenue -Spokane, WA 99260 (509) 456.-3675
SIGNATURE
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $" 25.00
EQUALS: TOTAL PERMIT
FEE -DUE
=$ 47°
13. CONTRACTOR'S RECEIPT
• INSTALLATION INVOICE. •
(i) 1_1 /a- /_/4:. ,
Pay to:
Store
Date
* 322941
Date paid:
N
E
2
3
DIV.
/f,.
i
WORK
ORDER #
CUSTOMERS
NAME
PERMIT
NO.
DATE
COMPL
INSTALLER
CHARGES
4
5
6
7
8
9
10
11
12
TOTALS
(FOR USE BY CASHIER)
CHECK
I)i
AMOUNT
All supporting detail must be attached.
1 certify that the installations listed above have all
been completed satisfactorily in accordance with the
specifications furnished me.
le
(DATE) (CONTRACTOR'S SIGNATURE)
5400 REV 10-69 (INSTRUCTIONS FOR CONTRACTOR PRINTED ON 3RD COPY)
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