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