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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