1993, 02-11 Permit App: 93000804 Furnace, ACs MEUHANIGAL PtHMII APPLICATION FORM
/ ` AJ� e 8-1 ,54-7 Irtoorin tion. worksheet
(J OB STREET ADDRESS: geR /i f i -.t 4 k -r!! . .1-1857
CITY/STATE/ZIP: ,4// 1 _ PARCEL NUMBER:
OWNER: &71/vt N 1-103 PHONE
PHONE NUMBER: 9..;2c/- 3 G; f
2 t
MAILINC3� ADDRESS: 3.9. v�/t.P_et ,42- fi - Lek-
J /(Street) (City/State) (Zip)
CONTRACTOR: ){J 04.41,,\ )d C/ & _
MAILING ADDRESS: Pr) a 370-7
(Street) -
LICENSE NUMBER: SE -A2 SE-37avp
PHONE NUMBER:t&' S
c ti,t e ,. id? 9. ('i
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT = AMOUNT
DESCRIPTION
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 ETU
HEATING EQUIPMENT +100,000 ETU
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 &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDITIONER 0-3 TONS
AIR CONDITIONER 3-15 TONS
AIR CONDITIONER 15-30 TONS
AIR CONDITIONER 30-50 TONS
AIR CONDITIONER +50 TONS
FANS
EVAPORATIVE 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 APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,0.00 CFM
AIR HANDLER >10,000 CFM
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00
2 . 00 =
x 194;
•-r- c =
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 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
/R. 00
NOTE: MINI I A E'+'IT FEE IS $35.00
SIGNATURE 4A046/11, z d. 4420d0
Sn3oka e ' fnty Department of Building and Safe
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$W.°4
W 1 03 Broadway Avenue Spokane, y pokane , WA 99260 (5d9) 456-3675
PAY T
n9d rt�iJIVOICE RECAP AND DISBURSEMENT -VOUCHER
ti,
not
STORE NO. 7/2 / / P
•
STORE K_// 8162162 r
,
No. 742241
DATE c:, -3 --93
•- CUSTOMER'S NAME
SALESCHECK
. NUMBER
JOB I.D. NO. OR•
WORK ORDER NO
AMOUNT
DUE
CONTRACTOR
' ALLOCATION OF EXPENSE - FOR INSTALLATION OFFICE USE
'
ACCOUNT.
NUMBER
• DIV.
NO.
ADJUSTMENT
ACCT.
ACCT.
CONTRACTOR
EXPENSE
MEMO
' SELLING
`An R.• 1 1
.0
_ ..: i
t
Cal�O
49
, .r
oat r-. � ,
•
,,
AVM I I Ct-
'
I certify that the installations listed above have all been
completed satisfactorily in accordance- with the speci
' fications furnished me. . -
(CONTRACTOR'S SIGNATURE)
•
TOTAL
AMOUNT
TOTALS
OK TO PAY PAYING UNIT NO 910-29
(AUTHORIZED SIGNATURE)
CHECK NO.
14489 (See Bul. 0-187 Part II Supp. 8) REV 3/91 SEARS FORMS MANAGEMENT
(DATE)
'ACCOUNTING COPY '
PAYING
UNIT NAME
IIf Different)