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1990, 12-17 Permit App: 90006815 Heat Pump MECHANICAL PERMIT APPLICATION FORM Info&coati n Workst)-eet JOB STREET ADDRESS: S/ n , CITY/STATE/ZIP: 0I/dab 14 O n,- -,7 PARCEL NUMBER: OWNER: ,00h L V (9/1A D f PHONE NUMBER:/ MAILING ADDRE36: 4)-:S7/ 2" cCC /�/1 fC�Pf%`1 P-Q d� (/l�?,OLcia /C0 6390 . 7 (Street) U (City/State) (Zip) CONTRACTOR: AO 67( LICENSE NUMBER:v Alp, - �c,=a i r PHONE NUMBER ^: (7 �j / - // MAILING ADDRESS: /J0/6 3-2 7 / LU�c?C!-�i1P,� /€)f 99G2 (Street) /(City/State) (Zip) OMMEMMIAMMIMEMMEMAWf _ 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 = _ HEATING EQUIPMENT <100,000 BTU x 12 . 00 = HEATING EQUIPMENT +100, 000 BTU x 15. 00 = GAS PIPING (1 - 4 OUTLETS) x GAS PI4,ING (5 OR MORE. EACH: ) x 1. 00 = REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12 . 00 = REFRIG 101-500M BTU x 20. 00 = REFRIG 501-1, 000M BTU x 25. 00 = REFRIG 1, 001-1,750M BTU x 35. 00 = REFRIG +1,750M BTU x 60. 00 = HEAT PUMP & AIR CONDITIONER 0-3 TONS _ _ I x 12 . 00 = HEAT PUMP & AIR CONDITIONER 3-15 TONS _ x 20. 00 = HEAT PUMP & AIR CONDITIONER 15-30 TONS _ x 25. 00 = HEAT PUMP & AIR CONDITIONER 30-50 TONS _ x 35. 00 = HEAT PUMP & AIR CONDITIONER +50 TONS _ _ x 60. 00 = VENTILATING FANS x 10. 00 = EVAPORATIVE COOLERS_ _ x 10 . 00 = TYPE I HOOD (PER 12 ' OR 12 ' PTN. OF HOOD) x 50 . 00 = TYPE II HOOD x 10. 00 = CLOTHES DRYER x 10. 00 = RANGE x 10. 00 = GAS LOG x 10 . 00 = MISCELLANEOUS (NOT COVERED ELSEWHERE)_ _ x 10. 00 = UNLISTED GAS APPLIANCE <400, 000 BTU _ _ x 50. 00 = UNLISTED GAS APPLIANCE >400, 000 BTU_ _ x100. 00 = USED APPLIANCE <400, 000 BTU x 50. 00 = USED APPLIANCE >400, 000 BTU x100. 00 = AIR HANDLER <10, 000 CFM x 12 . 00 = AIR HANDLER >10, 000 CFM x 15 . 00 = SUBTOTAL $ /a PLUS: PROCESSING FEE + $ 25 . 00 EQUALS: TOTAL PERMIT NOTE: MINI 4 FEE IS $35.,100 FEE DUE = SIGNATURE 14 �Gu 7 t(I DaJ Spokan - Cou epartment of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 3.- CON ALTO,R"S RibFCFIa r it -: 7 , INSTALLATION INVOICE Pay to: d Date paid is : 4 t' ; e L^�-u-.'�'1...� •` Store Date L I DIV WORK CUSTOMER'S PERMIT DATE INSTALLER E ORDER# NAME NO. COMPL CHARGES CONTRACTOR'S INSTRUCTIONS 11152 FOR FILLING OUT INSTALLATION INVOICE ©E Iffig, tPup, ''4 III 1. In Section "A", fill in business name and mailing address in upper left- III ©. 11. hand box. ' Q �--• 2. a. INVOICE FOR LABOR ONLY. Using the information on the ® -NM GOTC, complete Section "A" indicating the division, work order EMI= number, customer's name, date of completion and charges for labor --■ performed. j b. INVOICE FOR MATERIAL AND LABOR. A purchase order will be given with the GOTC for any material ,o ■ �-■ you are to furnish on a job, such as: a special plenum for an INadd-on air conditioner, pipe for water softeners, etc. When sub- mII mitting your invoice, follow Step 2a and list your labor charges ID -■ only. On the next line, in the column titled "Work Order #", put °%a the letters "P.O." and the purchase order number. Indicate the (FOR USE BY CASHIER) AMOUNT customer's name and the charges for the material supplied. I- c. If you work for more than one Sears store, submit a separate CHECK# invoice for each store. ,,,rting 3. Total the amount of the invoice & enter opposite word `Totals'. Do All sudetail must be attached. Not Enter Anything Opposite Words `Check #'. I certify' that the installations '' above have all 4. Remove the #4 copy and retain for your records. This will allow you "" cmpleted satisfactorily in wlth the specificationsfurn " 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 .. (CONTRACTOR S SIGNATURE) 15400 REV.10-69(INSTRUCTIONS FOR CONTRACTOR PRINTED ON 3RD COPY)