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1991, 11-21 Permit App: 91008103 Furnace
JOB STREET ADDRESS: MECHANICAL PERMIT APPLICATION FORM (,,e, ed Ir",formation Worksheet h CITY/STATE/ZIP:41,0j I (,04 603 /0 FAARCEL NUMBER: PHONE NUMBER: 9o2/ //(9. OWNER: e2G(,2trL .MJ7 MAILING ADDRESS: Lia 8 j__ _'1 /5/ 0 (f %2L \ I 0'�iic�l (� 99d� (Street) CONTRACTOR: x1 aA / MAILING ADDRESS: fie City/State) (Zip) LICENSE NUMBER: 6E- P 2- SJ - 37 %- PHONE NUMBER: L71 -61q- ion V,734 -/X Ggs4_k , £J) _- o (City/State) (Zip) (Street) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH .OF UNITS UNIT 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 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 EVAPORATIVE TYPE I HOOD TYPE II HOOD CLOTHES DRYER AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER FANS 0-3 TONS _ 3-15 TONS 15-30 TONS 30-50 TONS +50 TONS COOLERS (PER 12° RANGE OR 12' PTN. OF HOOD) 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 <10,000 CFM AIR HANDLER >10,000 CFM x$10.00 = x 25.00 = x 10.00 = x 12.00 = 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 = 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 = / '©O NOTE: nMIN SIGNATURE M� Pte_ T EE IS $3/?.00 00 SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ .3'7 Spokane Count4 (Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 PAY TOu INVOICE RECAP AND DISBURSEMENT VOUCHER t STORE NO. STORE No. 463456 DATE) / CUSTOMER'S NAME SALESCHECK NUMBER certify that the installations listed above have all been completed satisfactorily in accordance with the speci fications furnished me. (CONTRACTOR'S SIGNATURE) JOB I.D. NO. OR WORK ORDER NO. TOTAL AMOUNT OK TO PAY CHECK NO. 14489 (See Bul. 0-187 Part 11 Supp. 8) REV. 3/91 SEARS FORMS MANAGEMENT AMOUNT DUE CONTRACTOR ALLOCATION OF EXPENSE — FOR INSTALLATION OFFICE USE ACCOUNT NUMBER It DIV. NO. ADJUSTMENT ACCT. ACCT CONTRACTOR MEMO EXPENSE SELLING \ 7 • `1 • • TOTALS 11� (AUTHORIZED SIGNATURE) (DATE) PAYING UNIT NO. PAYING UNIT NAME (/f Different) TRANSACTION CODES DETACH BEFORE DEPOSITING I� REGULAR INVOICE ° FREIGHT REMITTANCE ADVICE 2. OUR MEMO BILLS 3. YOUR MEMO 9. FRT. CUT 4. RETURNED GOODS DOWN s ERROR ON INVOICE IF THIS REMITTANCE APPEARS TO BE INCORRECT HA a TRANSPORTATION CHARGES WRITE AT ONCE TO SEARS UNIT PRINTED BELOW T YOUR LETTER OR DUE C INV. MO. DATE I DAVI VR, INVOICE NO. AMOUNT SUPPLEMENTAL INFORMATION 111491469456 I I j37:000. 815HUP I I I I I I I I I I I I I I I I 1 I I 1 I I I i I I I I I I I I I I I I I I I I I I I I I I I I I 1 SPOKANE- HIPSP WA 004079 FORM R&D REV. (8-91) 11/15/91 narF 1 OF 1 RAGF NO. 6519519 CHECK NUMBER 37p0 CHECK AMOUNT DUNS NO r11 VENDOR IJO.I