1993, 01-14 Permit: 93000201 RefundPROJECT NUMBER= 93000201 ISSUE; PEkti'SIT
DATE= 01/14/93 PAGE= 01
**************************** PERMIT INFORMATION *+***** ***+ * *************
SITE STREET= 4211 S FOREST MEADOWS DR PARCEL#= 45333.0308
ADDRESS= SPOKANE WA 99206
PERMIT USE= GAS WATER HEATER
PLAT#= 000875 PLAT NAME=
BLOCK= 3 LOT=
AREA= 00000000 F/A=
# OF BLDGS= 1 # DWELLINGS=
FOREST MEADOW ADD
8 ZONE= SFR
F WIDTH=
1 WATER DIST
OWNER= DONOIAN, DARLEEN
STREET= 4211 S FOREST MEADOWS DR
ADDRESS= SPOKANE WA 99206
DIST#=
DEPTH=
VOID
E
R/W.,
PHONE= 509 927 4392
CONTACT NAME= SEARS PHONE NUMBER= 509 482 5685
BUILDING SETBACKS: FRONT= N/A LEFT= N/A RIGHT= N/A REAR= N/A
******************************* MECHANICAL PERMIT **************************
CONTRACTOR= SEARS
STREET= P 0 BOX 3707
ADDRESS= SPOKANE WA 99220
ITEM DESCRIPTION
PROCESSING FEE
GAS WATER HEATER
QUANTITY
Y
1
PHONE= 509 489 1170
FEE AMOUNT
25.00
10.00
******************************* PAYMENT SUMMARY ****************************
PAYMENT DATE
01/14/93
TOTAL DUE=
PERMIT TYPE
MECHANICAL PRMT
RECEIPT#
1814
.00 TOTAL PAID=
FEE AMOUNT
35.00
35.00
PROCESSED BY: DOMITROVICH, ROBIN
PRINTED BY: KATHY SQUIRES
PAYMENT AMOUNT
35.00
35.00
AMOUNT PAID AMOUNT OWING
35.00
35.00
.00
.00
******************************** THANK YOU *********************************
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�� g-� I� // Ipformation Worksheet /�
�r� JOB STREET ADDRESS: I 7 / A!.0�Co 4
CITY/STATE/ZIP:40444 f tO 9 9f)G' PARCEL NUMBER:
OWNER : ,ACJ?bM9!, ( -7.®-- A'L. PHONE NUMBER: 9,? 7- 5/5X;2-.
MAILING ADDRESS : )1 «'// I Lite ) A , te• /J 9 i9�'
(Street) ( ity/State) (Zip)
CONTRACTOR:Q.,��2 2 / % '� LICENSE NUMBER: -/q/e- .3%
-'r
�
PHONE NUMBER: ta4 ,37-3
yam- c,v�
•Z 370
MAILING ADDRESS: ,t'() .1-3-7r-7
(Street)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
461, 070.:uen
City/State) (Zip)
DESCRIPTION
= AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 --4 OUTLETS)
GAS PIVING (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
0-3 TONS
3-15 TONS
15-30 TONS
30-50 TONS _
+50 TONS
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
12'
PTN. OF HOOD)
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
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
1
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 =
y 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 =
/0. o
NOTE:
SIGNATUREa /IAA
MINIMUM I' EE IS $35.00
SUBTOTAL
$ /0, to
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
$
Spokane oun epartment of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
30I330 NOIIV1 1VISNI
s,4
yr
TOTAL
I-
CUSTOMER NAME
1%
•
k.
'`
WORKORDER OR
SALESCHECK NO.
3
TOTAL
INVOICE
COST
(TOTAL OF COLUMNS 7-13)
4
AND THE CERTIFICATE OF
IN
NOTE: If the Installation office unit
number is different than the
selling unit number, the total
dollar amount is to be atm'd
to the selling unit.
jj 69
P
TOTAL
LABOR
SELL
10
°'8
�nuvn rnll.rnYV vvvnfOnCC 1, v
COMPLETION - TO THIS REC
STALLATION OFFICE UNIT NO.
SELLING UNIT NO.
DIV. NO.
to
UNSOLD LABOR
DUE TO
INSTALLERROR
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AP)
6,
UNSOLD LABOR
DUE TO
ALL OTHER ERRORS
10
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;E# 157051
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