1990, 10-18 Permit App: 90005498 Water Heater MECHANICAL' PERMIT' APPLICATION FORM �? r
h` Information Worksheet w 6
JOB STREET ADDRESS: 77 /oaf C it ,Dii -.--.11,,A/t . `
1 `76411 , I�
CITY/STATE/ZIP: 1 �v ��? , �% ��I�EIk,PARCEL NUMBER: J
OWNER: y j,4zu g ,66i PHONE NUMBER: god - ;31)-7 v
MAILING ADDRESS: .,}1 , /.06 4� ln lf,,, v I L'4Q %
(Street) ity/State) (Zip)
CONTRACTOR: I/7 j J f (00,1$ i
LICENSE NUMBER: �5 I� - ��
/ PHONE NUMBER: '9' // 7D X34/6,
MAILING ADDRESS: P69,6 3 7 0 -Q-; /_/h8--- g92 2'o
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE. SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM x$10.00 =
WOODSTOVE/INSERT x 25. 00 =
GAS WATER HEATER: _ x 10.00 /D f n Ci
HEATING EQUIPMENT-<1.00,- 000- BT- U _ _ x 12.00
HEATINGEQUIPMENT. +100,0.00 BTU. x 1 .2S
GAS PIPING (1 ---21--OUTLETS),„: - - - x -4�:-0-6-
GAS'_,PIPING (�5 -OR" MORE. EACH: )=_ x 1.00 -
REFRIG -1-10 0M�.-BTU :(NOT A/C,OR-.HEAT PUMP) x 12.0 0 = ' •:
REFRIG_..101 500M::BTU =
GUNTHAGTUH"5 Kt(:tW 1
INSTALLATION INVOICE
Store
Date
Date paid:
029862
DIV.
ORDER #NAME
CUSTOMER'S
PERMIT
NO.
DATE
CO PL
INSTALLER
CHARGES
017. 109k
eta
10
11
12
TOTALS
(FOR USE BY CASHIER)
CHECK #
S"'
AMOUNT
00
5-
Lg.
M supporting detail must be attached.
I certify that the installations listed above have all
been completed satisfactorily In accordance with the
specifications furnished me.
(CONTRACTOR'S SIGNATURE)
CONTRACTOR'S INSTRUCTIONS
FOR FILLING OUT INSTALLATION INVOICE
In Section "A", fill in business name and mailing address in upper left-
hand box.
2. a. INVOICE FOR LABOR ONLY. Using the information on the
GOTC, complete Section "A" indicating the division, work order
number, customer's name, date of completion and charges for labor
performed.
b. INVOICE FOR MATERIAL AND LABOR.
A purchase order will be given with the GOTC for any material
you are to furnish on a job, such as: a special plenum for an
add-on air conditioner, pipefor water softeners, etc. When sub-
mitting your invoice, follow Step 2a and list your labor charges
only. On the next line, in the column titled "Work Order #", put
the letters "P.O" and the purchase order number. Indicate the
customer's name and the charges for the material supplied.
If you work for , more than one Sears store, submit a separate
invoke for each store.
off%
G
3. Total the amount of the invoice & enter opposite word `Totals'. Do
Not Enter Anything Opposite Words `Check #'.
4. Remove the #4 copy and retain for your records. This will allow you
to have a copy of all bills submitted but not paid. Attach all GOTC's
to support the entries, sign and date the invoice at the bottom of
Section "A" where indicated.
5. Submit invoice to the Installation Office to process for payment