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1991, 11-27 Permit App: 91008260 Mechanical Fixtures
JOB STREET ADDRESS: MECHANICAL PERMIT APPLICATION FORM Irtformation Worksheet 7 6„/ CI ,..$a(QC CITY/STATE/ZIP: ( 66749 /PARCEL NUMBER: OWNER : j�04 -C„ )AA j PHONE NUMBER : 9 a 9 � MAILING ADqDRESS : 71 a / yna)u_,ei 0L_, Sf maka,34,91 (Street) (City/State) (Zip) CONTRACTOR: MAILING ADDRESS: v\-.3 1 6p1)00-6_„ LICENSE NUMBER: SE -1412 S-!2 37c J7 PHONE NUMBER: -/--//7O )C 3 (1( , Gel 9 a acs 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 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 & 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 1 x$10.00 = x 25.00 = x 10.00 = x 12.00 = x 1 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 = /f fOO /- 00 NOTE: INIMUM PIT FEE IS $35.00 SIGNATURE n �� At� � %}, ,�Q/1/l� SUBTOTAL $ /3 . ©0 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE _ $ Spokane Corny Department of Building and Safety i 7&I....4 n4 Drn•ie1w i, Avanno gnniranP_ _ WA 99260 15091 456-3675 PAY TO-, VOICE RECAP AND DISBURSEMENT VOUCHER (1 STORE NO. r j j' STORE '�,:. No. 543007 DATE / / / ` (2/ CUSTOMER'S NAME SALESCHECK NUMBER AMOUNT ALLOCATION OF EXPENSE — FOR INSTALLATION OFFICE USE JOB I.D. NO. OR WORK ORDER NO. DUE CONTRACTOR ACCOUNT NUMBER DIV. NO. ADJUSTMENT ACCT. ACCT. CONTRACTOR MEMO EXPENSE SELLING A t , { _ �- C. -. F dz CC Y•< ill J Ilaa : ••,� .., ... (f'. h i. C F... F_,.(. f r` -.el..; 7,,.,.. ♦ V 1.' •,),..,. • . 1, i '/t•'LH •.1/.11. ,a, •I X),A ./� • \. i; •i. . ii, a. i- .i; .• a•►- • ;•1",4 ?AO, -4 •ill n L %'. ."••♦. •i•1 . 11 ,, i' v ,.'-e. •,'t1 it I N.•''S •) 1 it I, i 10 �. Ifs i•1 . ,5 ' y::T, �I 0 t , -4 r; T,,..g•'4 • ) i { I certifythat the installations listed above have all been completed satisfactorily in accordance with the speci fications furnished me. TOTAL AMOUNT �'?t =�_- TOTALS I., -AO. " • ,�• `^►,,• ` = AI i° i <:K• ; 'r♦•►?• c'' ,t+-+ �+ • ;;1-'L - i• < OK TO PAY - r'` 't'- . - •. PAYING UNIT NO if) (CONTRACTOR'S SIGNATURE) (AUTHORIZED SIGNATURE) CHECK NO. 14489 (See Bul. 0-187 Part II Supp. 8) REV. 3/91 SEARS FORMS MANAGEMENT (DATE) PAYING UNIT NAME (f Different) CONTRACTfR'S FII F CPPV TRANSACTION CODES 1 REGULAR INVOICE 8. FREIGHT 2. OUR MEMO BILLS 3 7099 MEMO 9. FRT. CUT 6. RETURNED GOODS DOWN ,i ERROR ON INVOICE 6. TRANSPORTATION CHARGES 7. YOUR LETTER OR 8AL. DUE DETACH BEFORE DEPOSITING REMITTANCE ADVICE IF THIS REMITTANCE APPEARS TO BE INCORRECT WRITE AT ONCE TO SEARS UNIT PRINTED BELOW SEARS 139 1 C INV. DATE MO. DAY YE. INVOICE NO. AMOUNT SUPPLEMENTAL INFORMATION 11 21 91 543007 3800 r2. GRLENWODU SPOKANE- HIPS, WA 004079 FORM R&D REV. (8-91) 11/22/91 DATE 1 UF 1 PAGE NO. 6539208 CHECK NUMBER 3b00 1 CHECK AMOUNT DUNS NO. (OR VENDOR NO.(