1992, 10-29 Permit App: 92009755 Mechanical Fixtures kAu,-rCvl ► Nso PaszL p,- MECHANICAL PERMIT APPLICATION FORM ` - S5
o . o i \ L'R'��° �� �I/r.formAtioA 'Worksheet itQc P
JOB STREET ADDRESS: 6, / j �� a 10423
CITY/STATE/ZIP 4 &1/h t 7 y 52- PARCEL NUMBER:
OWNER: A1 L/ �11 l _ PHONE NUMBER: 57Y- 9.„ 7-
MAILING ADDRESS: 6/7 Z ,d � ��
(Street) (City/State) (Zip)
CONTRACTOR VLOWl&d1 11._ LICENSE NUMBER: .%Y -/ / j/ '3 7 J7
PHONE NUMBER: l(g ,>` S-
MAILING ADDRESS: Po i :=3-70-? .. 1�����Q.� / ;?(/)
(Street) ity/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 = /j. 670
HEATING EQUIPMENT <100, 000 BTU / x 12.00 = /7. 00
HEATING EQUIPMENT +100,000 BTU x 1.P.i _
GAS PIPING (1 - -4 OUTLETS) / x �-&O / ' oh
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 ' 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 $
PLUS: PROCESSING FEE + $ 25. 00
EQUALS: TOTAL PERMIT- p�
NOTE: NIM RM E IS $35 00 FEE DUE = $
SIGNATURE r2,`( )i '741.2,1c149
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,
Spokane oun epartment of Building and Safety ,
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
/ IN OICE RECAP AND DISBURSEMENT VOUCHERH
/ /
PAY TO /_/Z. /�, / / i/i� /.%/ /'!/# '✓
/ / No. 742518
STORE NO. 4,427'97 j
1
STORE .(_ ?..g19."-.4-// — DATE / - ,
SALESCHECK JOB I.D.NO.OR
AMOUNT ALLOCATION OF EXPENSE—FOR INSTALLATION OFFICE USE 11
CUS1OMER'S NAME DUE ACCOUNT 1 DIV. CONTRACTOR MEMO
NUMBER WORK ORDER NO.
CONTRACTOR NUMBER NO. ADJUSTMENT ACCT._ ACCT. EXPENSE SELLING
(1/4; &,-2./ih,42-71__ g,, ,--78 4- 0(.2- .436g 422 ,..e)/
iv, 77.4,,,r,s-
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D/yiict--- i .
I cert fy that the installations listed above have all been TOTAL 44 -'completed satisfactorily in accordance with the speci AMOUNT TOTALS L� '
fications furnished me. I
y OK TO PAY PAYING UNIT NO. //irg
(AUTHORIZED SIGNATURE)
PAYING
CHECK NO. UNIT NAME '.
(CONTRACTOR'S SIGNATURE) (DATE)
(If Different)
i
14489(See Bul.0-187 Part II Supp.8) REV.3/91 SEARS FORMS MANAGEMENT
ACCOUNTING COPY