HomeMy WebLinkAbout1991, 04-08 Permit App: 91001627 FurnaceMECHANICAL PERMIT A,'PLUCATION FORMJ?
Information W,Orksheet
JOB STREET ADDRESS: 0(.0/c
CITY/STATE/ZIP:
OWNER: 0 i I (/)?/YlJij V cz41 0)
MAILING ADDRESS: )1 3(of Pit
PARCEL BER: O L .
PHONE NUMBER: 9910 533 C�
, )4- q 9 cD-
(City/State) (Zip) `
(Street)
CONTRACTOR: nn J#4 LICENSE NUMBER: 6E- i'1 f - S'IE 37c iV T
PHONE NUMBER: q0q ^ //'70 X 3t/9
MAILING ADDRESS: pp, 3`70-7 / GOA 99. i
(Street) f (City/State) (Zip)
MEMOMMEEMMMEMMEMMEMW
MECHANICAL
DESCRIPTION
WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
= AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PI?ING (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 &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS _
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
EVAPORATIVE COOLERS
TYPE 1 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
f
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.2A _
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
iINIMUM41
IT'1 EE IS $35.00
Spokane ount� �'�iartinent of Building and Safety
1303 Broadway Avenue Spokane,
SUBTOTAL
$ / , , 00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
West y WA 99260 509
( ) 456-3675
PPP:AY TOVIA -N)iICECAP ASD DISBURSEMENVOUCER
/tiJi
STORE NO.0 70,
STORE
No. 344.54
DATE ! C
f
CUSTOMER'S NAME,
SALESCHECK
NUMBER
JOB I.D. NO.
WORK ORDER NO. '
AMOUNT
DUE
CONTRACTOR
ALLOCATION OF EXPENSE — FOR INSTALLATION OFFICE USE
ACCOUNT
NUMBER
DIV:
NO.
ADJUSTMENT
ACCT.
ACCT.
CONTRACTOR
EXPENSE
MEMO
SELLING
hc)1411/f'%( f1 _. 1)0.41 (h1
t CO;`7R
3-7 c:L�
i
t "£
.,
)
51
2
3(f) I 6 �.
,,�
t AvCa' '1('_
C .Q
11E . .
L
' '
•
..--+
Rhi -
certify that the installations listed above have- all
been completed satisfactorily in accordance with the
specifications furnished me.
(CONTRACTOR'S SIGNATURE)
14489 (See Bul. 0-187 Part 11 Supp. 8)
TOTAL. •
AMOUNT
OK TO PAY
TOTALS
/1/ • r7.` ,
^x.
"*-7(AUTHORIZED SIGNATURE),
CHECK NO
•9/
• (DATE)
CONTRACTOR'S FILE COPY
PAYING UNIT NO.
,
PAYING
UNIT NAME
(If Different)