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1991, 11-27 Permit App: 91008409 Mechanical23 V'l MECHANICAL PERMIT APPLICATION FORM ©c) ao5u3 - �aoAO < e� 00oQ� Irformation `Worksheet S W S'C B JOB STREET ADDRESS: CITY/STATE/ZIP:YARCEL NUMBER: Cock. +Jo • S5 �f �' OWNER: Q�p�00�� ���Q���A- PHONE NUMBER: I?Q9 MAILING ADDRESS: -f--2-7062 a4,a (Street) (City/State) (Zip) CONTRACTOR: LICENSE NUMBER: )j - IqIQ - Qe - 3 %�/U PHONE NUMBER: Z/70 Y3V, MAILING ADDRESS: YDY��OT% (Street) City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE BER DESCRIPTION ' OFFUUNNITS I XUNITH I = 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_ _ -'-7 _ REFRIG 501 -1,000M -BTU _ _ _ _ _ REFRIG 1,001-1,750M BTU_ _ _ _ _ _ _ _ REFRIG+1,750M BTU___________ HEAT PUMP & AIR CONDITIONER 0-3 TONS HEAT PUMP & AIR CONDITIONER 3-15 TONS _ HEAT PUMP & AIR CONDITIONER 15-30 TONS _ HEAT PUMP & AIR CONDITIONER 30-50 TONS _ HEAT PUMP & AIR CONDITIONER +50 TONS VENTILATING FANS - - - - - - - - - - - - EVAPORATIVE COOLERS_ _ _ _ _ _ TYPE I HOOD (PER 12' OR i2' 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 >10,006: CFM. PLUS -:PROCESSING FEE 1+--$ 25�00- EQUALS:.TOTAL PERMIT NOTE: MI IMFEE IS $3 00 FEE DUE SIGNATURE Spokane Coun epartment of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 x$10.00 = x 25.00 = x 10.00 = x 12.00 = x 1 X. 1.00 = x 12: 00.-. x 20.00 = x 35.00 = x 60.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 10.00 = x 10.00 = x 50.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = / / _. _ SUBTOTAL PLUS -:PROCESSING FEE 1+--$ 25�00- EQUALS:.TOTAL PERMIT NOTE: MI IMFEE IS $3 00 FEE DUE SIGNATURE Spokane Coun epartment of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 PAY T 0_ (?)ml 'ptt;i� r_'J•')t L INVOICE RECAP AND DISBURSEMENT VOUCHER STORE NO. Cro--79 STORE,?& -1e1.0.44- No. 543011 DATE / / —9 7— 9 f ALLOCATION OF EXPENSE — FOR INSTALLATION OFFICE USE ACCOUNT DIV. CONTRACTOR MEMO NUMBER NO. ADJUSTMENT ACCT. ACCT. EXPENSE SELLING I certify that the installations listed above have all been completed satisfactorily in accordance with the speci fications furnished me. TOTALS OK TO PAY PAYING UNIT NO. (AUTHORIZED SIGNATURE) CHECK'NO. _ / //-x--2'7 - // PAYING UNIT NAME (CONTRACTOR'S SIGNATURE) • (DATE) (If Different) 14489 (See Bul. 0-187 Part 11 Supp.8) REV. 3/91 SEARS FORMS MANAGEMENT CONTRACTOR'S BILLING COPY