1991, 10-14 Permit App: 91006825 Water HeaterMECHANICAL PERMIT APPLICATION FORM, -i/
Information Worksheet of 6 1
/0003 77�� A,i ' L)
JOB STREET ADDRESS: [�J%
CITY/STATE/ZIP:4&4 a4'te , (sur- Q.9aC ARCEL NUMBER: D75-7 `-r -63',,;, i
OWNER: W1.04110 , m PA v ..L_oJ PHONE NUMBER: qa CO . o (R 9
MAILING ADDRESS: '€..- I (7 0 0 '3 "Y1evt_a__,J aca,,,,,p , um 99 a -O(
(Street)
CONTRACTOR: OAC / ,G(.e.4/4.--
MAILING ADDRESS:
0 3-70`7
(Street)
( ity/State) (Zip)/
LICENSE NUMBER:•52-/9(2-(SPE -3710-4)/-
PHONE NUMBER: 9-/ /70 X..31/54
461-404ar-Ce , (0/9- 99300
City/State) (Zip)
MECHANICAL WORKSHEET/FEE
DESCRIPTION
SCHEDULE
NUMBER
.OF UNITS
X EACH
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 =
1,14
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 30.00 =
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 =
/0.00
NOTE:
SIGNATUR
tQLNOM
IT FEE
$35.00
ekitk
l L!
Spok•ne Canty Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
SUBTOTAL
$ /0 0D
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 3�
INVOICE AND INSTALLER RECAP SHEET
INSTALLER TO ATTACH JOB DETAIL - LABOR PRICING WORKSHEET
INSTALLER/
/Ca
^Y �,L�oo,, L�(�1Ctj, ,�(��f/��
le('.,_ l V -e. � . adCi Pan (�j�
AND THE CERTIFICATE OF COMPLETION - TO THIS RECAP)
PAGE OF
�/',,
INSTALLATION OFFICE UNIT NO.
T
r V zCI/
/
DATE
II
NOTE If the Installation office unit
number is different than the SELLING UNIT NO.
total
/079
CHECK NO.
selling unit number, the
dollar amount is to be atm'd
o the selling unit. DIV. NO.
AMOUNT $
FED. I.D.#
CUSTOMER NAME
WORKOROER OR
SALESCHECK NO
SOLD
LABOR
UNSOLD LABOR
DUE TO
PRODUCT ERROR
UNSOLD LABOR
DUE TO
INSTALL ERROR
INSTALL
WHSE
CHGES
INSTALL
DELIVERY 8
HOLING CHGES
MATERIALS
SUPPLIED
TOTAL
COST
TOTAL
SELL
TOTAL
M/U%
it ,.0 3, -,ft M.
I )12..k,ee,19ss�13'
10- 1
CO
3s—
�— Com
- �,
S '
e
C/O riao
c•
n
TOTAL
$ --
$
$
$
$
$
$
$
$ 3SW.
sac 2Q
'H- %
ACCT.
ACCT.
ACCT
ACCT.
ACCT.
ACCT.
ACCT.
ACCT.
—
—
—
187-04-000
103-00-000
187-08-000
140-87-001
116-87-000
105-01-000
.14613(2/91), 1 -
Sears Forms Management
STORE
RANSACTION CODES DETACH BEFORE DEPOSITING SEARS AS
EGULARINVOICE 8 FREIGHT
OUR MEMO FILLSREMITTANCE ADVICE
YOUR MEMO 8 FRT CUT
ETUR ED GOODS IF THIS REMITTANCE APPEARS TO BE INCORRECT
ERRORTORNON DOORS °DWN 12 7 2 9 6 4
YOUR LETTER eniRoui WRITE AT ONCE TO SEARS UNIT PRINTED BELOW
C
MOF
X
yR
INVOICE NO
AMOUNT
SUPPLEMENTAL INFORMATION
1001
91
0t
3500W:1
LMA, ft. P11 ERCE
SPOKANE.; WA. 004 029
•
FORMRBD REV (891)
10/04/91
DATE
1 OFT 1
MGE NO
1 6408119:
CHECK NUMBER
; 35b01
CHECK AMOUNT
DUNS NO (OR VENDOR NO)