1993, 07-20 Permit: 93002695 RefundEPS PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
Cerffhndna Order
Blum.
Change Order #
Bid D_
Blanket#
RC#
VI#
FOB: PO DATE: BLDG/ROOM: BUYER
ACCTG. PERIOD: DELIVERY DATE: WAREHOUSE:
O DESCRIPTION
COMMODITY NO REF ACCT LINE QUANTITY UNIT UNIT PRICE TOTAL PRICE
— 4043 SOUTH FOREST MEADOWS DRIVE
100% REFUND JOB CANCELED—ANOTHER PERMIT ISSUED
UNE O R 8 ORO ACT I OBI I SB 01311 REV SRC I SB REV I RPT CAT BS ACCT TOB NO. PAY THIS AMOUNT PIF
RECEIVING CERTIFICATION PAYMENT CERTIFICATION TRAVEL CERTIFICATION
Materials noted in�pantiry d have been I, the undersigned do hereby certify under penalty of perjury that sufficient funds have been budgeted for this claim, the I hereby certify under penalty of perjury that this
receNed in good conditjbn or contracted for, materials have been furnished, services rendered or labor performed as described herein or contracted for, that the claim is is a true and correct claim for necessary expenses
/ a just, due and unpaid obligation against Spokane County or fund agency indicated above, that I am authorized to authenticate incurred by me and that no payment has been received
SIGNEI\) and certify to said claim. by me on account thereof.
i
TITLE SIGNED � TITf.E SIGNED TITLE
DATE DATE DATE PAGE
MCDA WMCKM 9
SPOKANE CoViNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY • SPOKANE, WA 99260-0050
(509) 456-3675
SITE INFORMATION _.� PROJECT INFORMATION
SITE ADDRESS: 4043 S FOREST MEADOWS DR
SPOKANE WA 99206
PARCEL NUMBER: 45333.0111
SUBDIVISION: FOREST MEADOW ADD
LOT: 11 BLOCK: 1 ZONE: SFR
INSPECTOR: DAVE SILVA
WATER DIST:
OWNER: GOFORTH, JOHN
PHONE: 509 922 6120
ADDRESS: 4043 S FOREST MEADOWS DR
SPOKANE WA 99206
PROJECT NUMBER: 93002695 ISSUE DATE: 04/20/93
PERMIT USE: GAS WATER HEATER, HEATING EQUIPMENT, & PIPING
APPLICANT: INLAND HEATING & COO
PHONE: 509 455 4147
ADDRESS: 3655 N GOVERNMENT WAY #12
COEUR D'ALENE ID 83814
CONTACT: INLAND HEATING & COO PHONE: 509 455 4147
SETBACKS -> FRONT: N/A LEFT: N/A RIGHT: N/A REAR: N/A
LENDER NAME:
PHONE:
ADDRESS:
Vs 0 1 D
PERMITS)
MECHANICAL PERMIT
CONTRACTOR
INLAND HEATING & COOLING
LICENSE #: SUNLOI*107J6
GAS WATER HEATER 1
GAS HTG EQUIP+100,000 B 1
GAS PIPING 2
PROCESSING FEE 25.00
TOTAL PERMIT FEE $52.00
PAYMENT SUMMARY NOTES
PAYMENT DATE RECEIPT# PAYMENT AMOUNT
------------ -------- --------------
04/20/93 00002854 $52.00
TOTAL FEES AMOUNT PAID AMOUNT OWING
------------- ------------ -------------
$52.00 $52.00 $.00
ISSUED PERMIT BY: DOMITROVICH, ROBIN
MECHANICAL PERMIT APPLICATION FORM
Infdrmation worksheet
JOB STREET ADDRESS:
CITYISTATE/Z1P:,�;,SOK&�
r� . , Z{ A. cl 'f �O PARCEL NUMBER:
OWNER: _, IMvc\ C Ut O 1'+ !'1 PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (IIP)
CONTRACTOR: Heat Transfer Inc. LICENSE NUMBER: Heatti-1881n
PHONE NUMBER: 482-2000
MAILING ADDRESS: N. 3003 Crestline Sookan•e WA 99207
(Street) (City/State) (zip)
..
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRICIDUCTW0RK (SEPARATE SYSTEMS)
x 10.00 =
v...W-uv...vn..;:.x:vx :: •.:vvvvMw: -•: n.�vv:nuw.•p:•: n4vMR 1v.\{{}vw.-A r:}: QM}y'v,)Q}¢tl`^}J:•:{.;;!{.ir \Cir!{. :
i:;::i,•_:}?tr { :'•hi`>?.�n{.;��t\"" ': }',rvi::i :"ri\ii 'M{::r'
�OOI�.Y;[;.O�r..f:,.';NL::v�ki?ji.::ti'}:.ki}rF''�•�,:i'••':isff.:::i{.\!YA-•lf.:\:Sitvyiiv�':iY%:�i\t;:•i.,vn'--•
x 25.x/0 0 =
...: :: •.vnri•••:inW-}wri;vi-0Giyw'S�wi\Lu.%v}�SiQvnL4viFwiin
3AS WATER HEATER
x 10.00
/0,00
;.
x 1200
. .
3AS EQUIPMENT +100,000 BTU DUCTWORK)
x 15.00 =
......... ..........
-AS pi::ING (-ZA.OU I LCI ;-.. _ .. -
X 1.00 -
:01LERIREFRIG 1-100M BTU
x 12.00
? RFFA�■^� i+-500._ $S1•€J'. �: +
x 20.00 =
301LERIREFRIG 501-1,000M BTU
x 25.00 =
..
J:?- f�:::h:.:-{:;y-}-};r.:%?: \;:.'::fir.: J:. -.:y_,J✓p LE€�"I..REFF1tC fl��(I�:=:.,%:Si0M�8'T'(�.::<�:�. r.'.K<;-y-:,:�.:�:. -�
x35.00 _
--.-.-
IOILER/REFRIG +1,750M BTU
x 60.00 =
iEA_T f?JMP<_A`IRCSNDITIONEA%:D 3 TONS;} `=
x 12.00 =
[EAT PUMP & AIR CONDITIONER 3-15 TONS
x 20.00 =
mmm
IEA,Pt1.liSP-8�AI-',>CO .pf:: ONEF3't50�}TONSµ `'"
x 25.00 =
'EAT PUMP & AIR CONDITIONER 30-50 TONS
x 35.00 =
y:.,M:�+Me••::-?xM:a^roc::...w:ro.:..M•r..,.•,:-�!�caK'.vx.!e.....:-v""n"'r^-_xw}::_:<{x{{a?il-;w :
EA_T=P_UI�IP>°_AIFCONpfTIONER,+5.Q:TANS=>:><>>=`<'>;='
x 60.00 =
ENTILATING FANS
x 10.00 =
w.,.CER+>;>�.};::>;;;;r::.�>.�:::::_:::r;{-,.....;ri:;>f:.;::>r::r:�:;•:
YAPORATIVE;CClO S
x 10.00
.. .n }n..w:�:xrti-+.Ov�H%:n4'0]i.+F.wCOYFl.•iGi:Lvw}i%!h.S;!4C{!{iv..\IS++SU:'F�":i: }J'.•J2n:h:
YPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
x 50.00 =
x 10.00
LOTHES DRYER
x 10.00 =
wNvx w.r:y..i;.{fv.}.}:}:.•.+f{r?yvM,i?k}l4.{:',w; x. r?.:C}stM:n!.Y.!i! :T}v:Otx.:{MYf' v:i-':-' 7MS:;Cy,.r :,. .!.;:..
AN -
x1 0.00 =
AS LOG
x 10.00 =
rsNFo'EWH�
x 10.00 =
•n:twvh:\vm.vFnv,.:-m w�
VUSTED GAS APPLIANCE <400,000 BTU
x 50.00 =
aN:ST� SAP, P.t tA�C,4�r�0.':8.
x100.00 =
3ED APPLIANCE <400,000 BTU
X50.00 =
','r{
x100.00 =
nMnw.,wnvMw � rv.,ii..v:w..�°.•
R HANDLER <10,000 CFM_
X_1200 a
^-^ro y: '^"'^"?y^b�'•' .,F;}.rgkl?l,.vro-:Yo:" }•+ i. At�]SCI`R��y�0::0�0Q0>�>��;�:X>,'.'>::,:<:;:.>>";:�;w..:..{:,;f�:<.:::�.:�T.:
X 15.00 =
SUBTOTAL I $ 44 VG
PLUS: PROCESSING FEE I+$ 25.00
)TE: MINIMUM PERMIT FEE IS $35.00 EQUALS: TOTAL PERMIT
FEE DUE =$ 'W,60
3NATUR
Spokane County Division of Buildings
West 1 026 Broadway Avenue Spokane, WA 99260 (509) 456-3675 -G,�3
SITE ADDRESS: S 4043 FOREST MEADOWS DR
PROJECT NUMBER: 93002695 ,PERMIT TYPES: ME
PERMIT USE: GAS WATER HEATERIHEATING EQUIPMENT a PIPING-7/23—JOB C.ANCELE
DESCRIPTION INSPECTOR DATE RESULT
-------------------- ------------------------- -------- --------------------
/OIDED/EXPIRED JOELL WANDS 07/23/93 APPROVED
SITE ADDRESS: 5 4043 FOREST MEADOWS DR
PROJECT NUMBER: 93002695 1 PERMIT TYPES: ME
PERMIT USE: GAS ',DATER HEATERIHEATING EQUIPMENT a PIPING-7/23-JOI CANCELE
DESCRIPTION
INSPECTOR
DATE
RESULT
--------------------
--------------------
GAS PIPING
-------------------------
WILLIAM ZEHM
--------
07/29/93
APPROVED
VOIDED/EXPIRED
SITE ADDED ADDS RECORD
01/24/94
APPROVED