1993, 06-15 Permit: App: 93004536 ACJOB STREET
CITY/STAT `
OWNER:
MAILING AD
MECHANICAL PE! APPLICATION FOR
Tr.fofna n. ksheet
ADDRES:
/ZIP. ✓ .7t PARCEL NUMBER:
di - �� = II _ %r PHONE NUMBE
DR �S _
(Stree
V 5.8Cf7S7o
CONTRACTOR* A
MAILING ADDRESS:
4 //
(City/Stat) (Zip)
ICENSE NUMBER: 5/%- '5,04) /V/r--
PHONE NUMB
(Street)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTIONNUMBER X EACH
OF UNITS UNIT
City/Stage)
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 --4 _4, OUTLETS )
GAS PI?ING (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 & AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' P'I'N. OF HJOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
3-15 TONS
15-30 TONS _
30-50 TONS _
+50 TONS
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 >400,0_00 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
x$10.00 =
x 25.00 =
x 10.00 =
x 12.005 =
x 1rJ4-0
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 =
NOTE:
SIGNATURE
MUM PERMIT PEE IS $35.00
SUBTOTAL
PLUS: PROCESSING FEE
(Zip)
= AMOUNT
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Snnkane_ WA 449nn /tim ARRAR7c
(See Bul. 0-187 Part 11 Supp. 8) REV. 3/91 SEARS FORMS MANAGEMENT
AdOO JNI1Nfl000V
(3IIn1vNJIS S.1IO10Va1N00)
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I certify that the installations listed above have all been
completed satisfactorily in accordance with the speci
fications furnished me.
IL
CUSTOMER'S NAME
A
SALESCHECK
NUMBER
JOB I.D. NO. OR
WORK ORDER NO.
Ai
OK TO PAY PAYING UNIT NO. 7
TOTAL
AMOUNT
`11h°Sk
MOUNT
DUE
CONTRACTOR
ACCOUNT
NUMBER
ALLOCATION OF EXPENSE — FOR INSTALLATION OFFICE USE
o .
ADJUSTMENT
D
0
n
1
D
0
n
ri
V
N\s,
(CONTRACTOR(
EXPENSE
MEMO
SELLING 11
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