1990, 05-03 Permit App: 90001873 Reroof i
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INFORMATION WORKSHEET / I7
PARCEL NUMBER: Q L7 q q- v-�� 2
STREET ADDRESS: , - 7._-f(--,Ac---- _j_21/_-y•C J
CITY/STATE/ZIP: I I,' _d_{ J / GOA 9-9,_;!, / :,
SUBDIVISION:
BLOCK: LOT: ZONE: = -`DISTRICT:
LOT AREA: _._.. - B/A: WIDTH: DEPTH: R/W:
4 OF BUILDINGS: . - 4 OF DWELLINGS: WATER DISTRICT: ...
OWNER: ` PHONE:� 9 - f,17- 4(.__17
MAILING ADDRESS: .. 2K)
CITY/STATE/ZIP: --k 1 / LSC/4 - ��/ :, .
CONTACT: I '�'� et.4( 2 ��. PHONE: y�� 9 - 49 - 7 7 K
SETBACKS: - FRONT: LEFT: RIGHT: REAR:
PERMIT USE: 0°e7 /D
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BUILDING INFORMATION
CONTRACTOR L CENSE NUMBER: `-/2/e- `;',43 74- 3 2c9//T-
CONTRACTOR: /VI-14f_ 11 Q-vt _ PHONE: ®9 - 49- //7'D ,1(3V ,.
MAILING ADDRESS: 1-20 7 4/41. /- / ala - (.ci
ARCHITECT/ENGINEER: PHONE: - -
MAILING ADDRESS:
NEW: ODEL: ADDITION: CHANGE OF USE:
DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES:
BUILDING DIMENSIONS: X (WIDTH X DEPTH) SQ. FT. :
REQUIRED PARKING: 4 HANDICAP: SEWER (Y/N) : HYDRANT:
3. CONTRACTOR .: -':CEIPT ® 12 4 8 8
0 - INSTALLATION INVOICE 0
Pay to: Date paid:
,' Store
/ Date
L
I DIV. WORK CUSTOMER'S PERMIT DATE INSTALLER
N ORDER# NAME NO. COMPL CHARGES CONTRACTOR'S INSTRUCTIONS
1 FOR FILLING OUT INSTALLATION INVOICE
2 1. In Section "A", fill in business name and mailing address in upper left-
3 hand box.
4 2. a. INVOICE FOR LABOR ONLY. Using the information on the
5 _ GOTC, complete Section "A" indicating the division, work order
6 number, customer's name, date of completion and charges for labor
7 performed.
8 b. INVOICE FOR MATERIAL AND LABOR.
9 A purchase order will be given with the GOTC for any material
10 you are to furnish on a job, such as: a special plenum for an
add-on air conditioner, pipe for water softeners, etc. When sub-
11 mitting your invoice, follow Step 2a and list your labor charges
12 only. On the next line, in the column titled "Work Order #", put
TOTALS , 74 r4 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.
l
. /�f c. If you work for more than one Sears store, submit a separate
CHECK#
• invoice for each store.
3. Total the amount of the invoice & enteropposite word `Totals'. Do
All supporting detail must be attached.
Not Enter Anything Opposite Words `Check #'.
I certify that the installations listed above have all 4. Remove the #4 copy and retain for your records. This will allow you
been completed satisfactorily in accordance with the
specifications furnished me. 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
(DATE) (CONTRACTOR'S SIGNATURE)
15400 REV.10-69(INSTRUCTIONS FOR CONTRACTOR PRINTED ON 3RD COPY)