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1992, 09-18 Permit App: 92007841 Gas Log, PipingLS ((0 a . ) (aO '.MECHANICAL PERMIT' APPLICATION FORM c a _- ti 1 0p.P 1 �( v.. Z g c2 Ir f ctrmat4on Worksheet JOB STREET ADDRESS: A // cane/ %% � 9--( 3«1Q ) CITY/STATE/ZIP: ARCEL NUMBER: OWNER: /7t . 0=6 -g-47-- PHONE NUMBER: 9,2Y -(/2-7V233 MAILING ADDL j a LY,RSS : E //,{j c7o 77et 11c9- - ,,d -L(. , L q9 c/ (Street) (City/State) (Zip) CONTRACTOR:49 /aAte,tjAlie,LICENSE NUMBER: SE- / -.5//- .f57.0-,t),7- PHONE 37 4)PHONE NUMBER: 9g "',j6,f��- MAILING ADDRESS: A4 '-7 7 (Street) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION 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 & HEAT PUMP & HEAT PUMP & HEAT PUMP & HEAT PUMP & VENTILATING 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 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 12.00 = x -44-G00- 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 = Y 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 = /. ©d /D. 02) NOTE: IN M SIGNATURE FEE IS $.35.00 SUBTOTAL PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ Spoka e C' ' le Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 INVOlUE AND INS IALLEK KLUAI' SHEE I 14613 (2/91) Rev. 9/91 'Sears Forms Management INSTALLATION OFFICE (INSTALLER TO ATTACH JOB DETAIL - LABOR AND THE CERTIFICATE OF INSTALLATION INSTALLATION NOTE: If the Installation office unit number is different than the selling unit number, the total dollar amount is to be atm'd to the selling unit PRICING COMPLETION OFFICE SEWNG SOLD LABOR 7 WORKSHEET, - TO THIS RECAP) UNIT NO. UNIT NO./00 DIV. NO UNSOLD LABOR DUE TO PRODUCT ERROR 8 WAIVER OF LIEN, AMOUNT COST UNSOLD LABOR DUE TO OTHER ERRORS 10 $ INVOICE # 170531 i TALLER L.t/+�J ' 7) �,�% 79 C' PAGE DATE 11 OF / /9(9FEQ G- UNSOLD LABOR DUE TO INSTALL ERROR 9 ALL (p # 12 13 CUSTOMER NAME 1 FOCIS DONE f 2 WORKORDER OR SALESCHECK NO. 3 TOTAL INVOICE COST (7� OF COWAN'S 7-13) 4 TOTAL LABOR SELL 5 TOW LABOR M/U% 6 d/, ea , ,_4. eeir TOTAL $ $ { 122— /7 % $ .------JJ/ACCT. $ $ $ $ $ $ ACCT. ACCT. ACCT. ACCT. ACCT. ACCT. APPROVAL (MGR. SIGNATURE) DAT 187-04-000 103-00-012 187-08-000 103-00-000 14613 (2/91) Rev. 9/91 'Sears Forms Management INSTALLATION OFFICE