1992, 10-29 Permit App: 92009750 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM
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Irformati Worksheet �-���� ,
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JOB STREET ADDRESS: � /�� �"
CITY/STATE/ZIP-4_,A; ->, ` i . ll . ) PARCEL NUMBER:
OWNER: C/,G z-i ,/l� �l( i PHONE NUMBER �� ��--
MAILING ADDRESS: �� s �/ ' D
(Street) U � (City/S/tate) (Zip)
CONTRACTOR1 r 2// ;// '12.ce W__. LICENSE NUMBER:,,,Z--/I,
PHONE NUMBER: /N ; 5
MAILING ADDRESS: ?6 �;� / j /(
(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 =
HEATING EQUIPMENT <100,000 BTU / x 12.00 =
HEATING EQUIPMENT +100,000 BTU x 1;49 =
GAS PIPING (1 -4 OUTLETS) x .4-re-6-= /e7
GAS PIING (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 _ _ 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 ' P'I'N. 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 $ �? �-
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT
NOTE: IN7 .UM Li E IS 15.00 FEE DUE = $ W(M-
SIGNATUR _
Spoka e C, e Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
VOICE RECAP AND DISBURSEMENT VOUCHER
I PAY T• /.4,1/x, i , ': .. _ ��;.�
i Na. 742520
STORE NO. 9��
STORE DATE '0 ?, /.
SALESCHECK JOB I.D.NO.OR I MOUNT
ALLOCATION OF EXPENSE—FOR INSTALLATION OFFICE USE
1 7
CUSTOMER'S NAME NUMBER WORK ORDER NO. DUE ACCOUNT 1 DIV. CONTRACTOR MEMO
CONTRACTOR NUMBER NO. ADJUSTMENT ACCT.- ACCT. 1 EXPENSE SELLING
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I cert. y that the installations listed above have all been TOTAL
completed satisfactorily in accordance with the speci AMOUNT ( 11� TOTALS I e-- 2-
' /'
fications furnished me. /
OK TO PAY PAYING UNIT NO.
(AUTHORIZED SIGNATURE)
PAYING
CHECK NO. UNIT NAME
(CONTRACTOR'S SIGNATURE) (DATE) (If Different)
14489(See Bul.0-187 Part II Supp.8) REV.3/91 SEARS FORMS MANAGEMENT
ACCOUNTING COPY