1993, 02-17 Permit App: 93000928 Water Heater, Pipingq50as ,411 _z�r MECHANICAL PERMIT APPLICATION FORMG� z
���� p(� Ir. formation Worksheet t
re JOB STREET ADDRESS: '� e-_ CJ(4��,(Q
CITY/STATE/ZIP: 4 p, ril.,f" 1(�2' cit,g/PARCEL
OWNER: Jia 1 (494.a-
MAILING
Y 4L
MAILING ADDRESS: #3/-3i1.
(Street)
CONTRACTOR: f
MAILING ADDRESS : '"0 a .3 -) 0
(Street)
NUMBER:
PHONE NUMBER: c% 5/, /e,p
atoA_A�,.e _ /.t ql�/
(City/State) (Zip)
LICENSE NUMBER: SE -/e/12 -.5/2- •3.7.,2217 --
PHONE NUMBER: *8' ? -SI, &-s-
4 a �,,? Pt zeh Q9Q,96
/(City/State) (Zip)
laMEMOMMEMBEIMICSEIN
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTIONNUMBER X EACH
OF UNITS UNIT
= AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 ETU
HEATING EQUIPMENT +100,000 ETU
GAS PIPING (1 - -4 OUTLETS)
GAS PIPING (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 0-3 TONS
AIR CONDITIONER 3-15 TONS
AIR CONDITIONER 15-30 TONS
AIR CONDITIONER 30-50 TONS
AIR CONDITIONER +50 TONS
FANS
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HJOD)
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
"j
x$10.00 =
x 25.00 =
x_ 10.00 =
x 12.00 =
x 1=
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 =
/0.070
/ E Z
NOTE:
MAJel
SIGNATURE y
MUM
IT FEEtIS $35.00
Spoka
West _1303, :
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
e C my Department of Building and Safety •
roadway Avenue Spokane, WA 99260 (509) 456-3675
: �JN VOICE RECAP AND DISBURSEMENT VOUCHER
STORE NO. 40-79
9
STORE G2-iket s e ---
DATE
CUSTOMER'S NAME
SALESCHECK
NUMBER
JOB I.D. NO. OR
WORK ORDER NO.
AMOUNT
DUE
CONTRACTOR
ALLOCATION OF EXPENSE — FOR INSTALLATION OFFICE USE
ACCOUNT
NUMBER
DIV.
NO.
ADJUSTMENT
ACCT.
ACCT.
CONTRACTOR
EXPENSE
MEMO
SELLING
.g.a38?5
I certify that the installations -listed above have all"been
completed satisfactorily in accordance with the speci
fications furnished me.
(CONTRACTOR'S SIGNATURE)
TOTAL
AMOUNT
TOTALS
36
OK TO PAY PAYING -UNIT NO.
(AUTHORIZED SIGNATURE) '.
019
PAYING •
CHECK NO. UNIT NAME
(DATE) " . (If Different)'
14489 (See Bul. 0-187 Part II Supp. 8). REV. 3/91 SEARS FORMS MANAGEMENT.
ACCOUNTING COPY