1992, 09-11 Permit App: 92007507 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Ir.formation Worksheet 9a-7 507
JOB STREET ADDRESS:,LI/ (20/7/i 7 (��,�yt(L� -7 302.c.
CITY/STATE/ZIP: 4a ,ItIo n PARCEL NUMBER:
OWNER: /,flj, Q. & ad) PHONE NUMBER: $09. 9a R ' 967
MAILING ADDRESS: Cr • 90/17 (7j0_4(All J 1tn,, lai 992-/a
(Street) (City/State) (Zip)
CONTRACTOR: VfiJ2t4/0-4244 44 LICENSE NUMBER: SE-f//Q SP- -3-2c9/1)7-
PHONE NUMBER:, 7.12- Or '2 • noft-
MAILING ADDRESS: Po 6 3-7 0'7
(Street)
40./aan, p / 2h. 99 0
'(City/State) (Zip) 1
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 & AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 15-30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & AIR CONDITIONER +50 TONS
VENTILATING 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 <10,000 CFM
AIR HANDLER >10,000 CFM
l
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 1-4-.$ee- =
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: MINIMUM i FEE IS $3.00
SIGNATURE4.4kAte- .Q(
�� Spokan Coun Department: of. Building .and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_ $ 371a:I
•
JCE FACTORS
RESIDENTIAL HEATING SPECKS .
7 •
1.L=1‘IGTri OF ° 'N= c� .
2. T'r'E=MCS T AT A. GCCC VC ;L/
E. AVG.
-. _ r4CAL PANEL
E. AMF. 200
C. MLN!
tT,_NC: :) 41 75 07 4/1�6
CZNCENS'ATE FL:ml= (jSTI i -1G4'
NC
_! WE3 NICTCF.
vre
NO
n� :TING SYSTEM
71=C
CIF=77
°- 7
PAY TO
NVOICE RECAP. -AND DISBURSEMENT VOUCHER I
•
STORE NO Volt?
, 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
,- a ,r .,i,
8 a7,
i 2 37a7
..
37
/fl2
�7C°
,o/
>t6�a
K
'Yl, ,an/7 2«i
itllQ
Ccut
.
�„
\4
•
•
•
P��1--
I certify that the installations listed above have all been
completed satisfactorily in 'accordance with the speci.
fications furnished me.
,
TOTAL -•
AMOUNT
1/45
, TOTALS '
•
••
z7
e
OK)TO PAY
,
PAYING UNIT NO44,0
YJ '
(CONTRACTOR S' S I G N ATU R E)
CHECK NO.
(DATE)•' •
•
1489 (See Bu1.0-187 Part 11 Supp 8) REV .3/91 SEARS FORMS MANAGEMENT
ACCOUNTING COPY
PAYING
, UNIT NAME -
. (If Different)