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1990, 05-16 Permit App: 90002137 Water Heater• HART'CA'.' PERMIT APPLICATIONFORM ,In1rIaation orks2 eet ; w,> X PARCEL NUMBER OWNER - MAILING ADDRE�S: PHONE,, NUMBER CONTRACTOR: am0)4_ ?z,-)27,/, ity%Stat) r0, 432,.3;" tb) :04 vio PHONE NUMB • . _ MAILING = ADDRESS : (Street) City/Stat •.t MECHANICAL WORKSHEET/FEE SCHEDULt°"'� ..DESCRIPTION NUMBER - OF UNITS X EACH -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 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 & HEAT PUMP & HtAT PUMP & HEAT PUMP & HEAT PUMP & VENTILATING EVAPORATIVE 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 COOLERS TYPE I.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- APLIANCE4400; 000 - BTU USED APPLIANCE •<400 400 'BTU _ USED APPLIANCE- >400;000-J3'1737 AIR `HANDLER'<10, 000'` CFM- AIR ; HANDLER' ->10:, 000 ::CFM NOTE: .: 1(I MUM PERMIT EE I $35.00 SIGNATURE !! ZZ West 1303' B oadway Avenue mSpokanBuilding jiWA-99260'15 09) 456-3675 Y +:u SUBTOTAL;;;` x$10.00 x 25.00 x 10.00 x 12.00 x 15.00 x 4.00 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 x10.00 x 10.00 x 50 00 -x100.00 1c50.00 x10.0.00 xe12 . 0 0 r. tFo' 0 PLUS :4gROCESSING FEE 5.00 EQUALS .TOTAL'kPERMIT ;EEE DUES?`-' .... 3. CONTRACTOR'S RECEIPT 0 Pay to. t( s INSTALLATION INVOICE %!, Store Date Date paid: 012245 • I N E DIV. WORK ORDER # CUSTOMER'S NAME PERMIT NO. DATE COMPL INSTALLER CHARGES / 7 2 tit. F � 3 4 5 s 7 8 r 9 10 11 Int 12 TOTALS (FOR USE BY CASHIER) CHECK 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. 1 DATLI (CONTRACTOR'S SO LATURE) 15400 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