1992, 11-24 Permit App: 92010293 Range, Piping�3 �� mtUnMcn
nIuM,. rrui MrrLit,Mtiuri
on W
NN JOB STREET ADDRESS: j g./9 Irformatiorksheet
,C/ v o eldest p ida • 99X2PARCEL
/�pQf%p PHONE NUMBER://
ailpetirp ,1h %9a,7-
( ity/State)- (Zip)
NUMBER:5 -/ A9-S,e - 3%2,v,r
NUMBER: cic 0 --C-
�prF140C�p, (6P9,6 ()
CITY/STATE/ZIP:
OWNER: ��g/ /i
MAILING ADDRESS:
roma
9a1cz93
SIG
NUMBER:
68-) 9
Q (Street)
CONTRACTOR: JGYM„/\111��%2
e
MAILING ADDRESS: Yo ""7 7)-7
LICENSE
PHONE
(Street)
wasiimitImuimartrzr
MECHANICAL
DESCRIPTION
(City/State) (Zip)
WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
= 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
x$10.00 =
x 25.00 =
x 10.00 =
x 15
x2.00 =
1 -J -r-6 G6 _
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 =
/.op
NOTE: / I.r_MUM PE
SIGNATOR
ES IS $35_00
12A Q
Spoka Colin 'moi epartment 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
INVOICE AND INSTALLER RECAP SHEET •
(INSIALLtH IU Al IAGH JUIB UtIAIL - LAWN HHIOINU WUHKSHtt I, WAIVtH UI- LItN,
^ ^
INSTA�LL�EEJJR,�,
AND THE CERTIFICATE OF COMPLETION - TO THIS RECAP) INVOICE #
LV• l6 54
�/y� ,_ ��JJ� ��J/�J ��JJ
GieCt y Ims
i`G!F!'I.NO ...4 /Y'f,P l
INSTALLATION OFFICE UNIT NO
0,79
U
AMOUNT $
U
/
NOTE If the Installation office unit
number is different than the SELLING UNIT NO.
the total
/0c:97
PAGE OF
selling unit number,
dollar amount to be atm'U
// //c/9c
FED. I D.#
to the selling unit DIV NO
a -
DATE
CUSTOMER NAME
1
FOCIS
DONE
2
WORKORDER OR
SALESCHECK NO(TOTAL
3
TOTAL
INVOICE
COST
OF COLUMNS7-13)
4
TOTAL
LABOR
SELL
5
TOTAL
LABOR
M/UY
6
SOLD
LABOR
7
UNSOLD LABOR
DUE TO
PRODUCT ERROR
8
/
UNSOLD LABOR
DUE TO
INSTALL ERROR
9
UNSOLD LABOR
DUE TO
ALL OTHER ERRORS
10
11
12
13
A/r leggslA,
//— /1
o&Wg& ,
39
,�9
�--
.�i�
L.1
/1
•
÷-i-C-904/r)/7
•
TOTAL
$ �^y-./ en--
t ,39C22 ---C22---
°h
15? (20---'s
$
$
$
$
$
`/ /
(CD
7r
// //c7--
ACCT.
ACCT
ACCT.
ACCT.
ACCT.
ACCT.
ACCT.
APPROVAL (MGR. SIGNATURE) DATE
187-04-000
103-00-012
187-08-000
103-00-000
14613(2/91) Rev 9/91
Sears Forms Management -
INSTALLATION OFFICE