1992, 12-01 Permit App: 92010506 Gas Log, PipingH3-5 7 j1 o Irformation Worksheet
$° JOB STREET ADDRESS: /-39/�p �%7/a/ a.a_
CITY/STATE/ZIPS ?W7/(2 /42 PARCEL NUMBER:
OWNER: n/,),-)IdyikoIx/=1 PHONE�
S NUMBER:
MAILING ADDRESS: / =j /�p %�� a�_�a� /a'O_ze7, 1��-z
(Street) (City/State) (Zip)
CONTRACTOR :/ i'/��j /Z �� '�/'��LICENSE NUMBER:5g %`'17,2
PHONE NUMBER :X9 ���
yam v v
aa�
MAILING ADDRESS : (2() / - `79
\\I\
(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 PIRING (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 0-3 TONS
AIR CONDITIONER 3-15 TONS
AIR CONDITIONER 15-30 TONS
AIR CONDITIONER 30-50 TONS
AIR CONDITIONER +50 TONS
FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HJOD)
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 <10,0.00 CFM
AIR HANDLER >10,000 CFM
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
7J.210
•4--6
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 =
/,00
v o
NOTE: MI I. FEE IS $3 00
r•
SIGNATUR .010
Spoka e Co % Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
SUBTOTAL
PLUS: PROCESSING FEE
$ //,e'zr
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
INVOICE AND INSTALLER RECAP SHEET
(IIVJ IHLLtIY I V HI IHl.tt JVt3 lit IHIL - LHCVH YHII,,INU VVVINKJF1tL I, VVAIVLH UI- LILN,
ti R
AND THE CERTIFICATE OF COMPLETION - TO THIS RECAP) INVOICE #
156680
/
"'�� fi',/,
/,I � ` �.it , (G %• �i
` l ' INSTALLATION OFFICE UNIT NO.
e72
��
AMOUNT $
NOTE: If the Installation office unit
number is different than the SELLING UNIT NO.
/6� J C/
PAGE OF
selling unit number, the total
dollar is to be 'd
amount atm
/�
// //
#
tt
to the selling unit. DIV. NO
UUYY7
DATE r '�/-1
FED L D
CUSTOMER NAME
1
FOGIS
DONE
,i/
2
WORKORDER OR
SALESCHECK NO
3
(TOTN.OF
TOTAL
INVOICE
COST
COLUMNS 7-13)
TOTAL
LABOR
SELL
5
TOTAL
LABOR
M/U%
6
SOLD
LABOR
78
UNSOLD LABOR
DUE TO
PRODUCT ERROR
UNSOLD LABOR
DUE TO
INSTALL ERROR
9
ALL
COST
UNSOLD LABOR
DUE TO
OTHER ERRORS
10
11
12
13
)--26-,),,i127, p-,
1 / O
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l
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We c
1
TAL
$
$ ��
J %
$3r
tACCt JT.
$
$
$
$
$
$
/ (/T
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ACCT
ACCT.
ACCT.
ACCT.
ACCT.
ACCT.
APPROVAL (MGR. SIGNATURE) DATEffff
187-04-000
103-00-012
187-08-000
103-00-000
14613 (2/91) Rev. 9/91
Sears Forms Management
INSTALLATION OFFICE