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1992, 02-27 Permit App: 92001118 Mechanical Fixtures 17 `-ociro MECHANICAL PERMIT APPLICATION FORM n LAS pew I.-to C3'-/ Ir.formation *Worksheet Gid,. ill 8 JOB STREET ADDRESS: /d 36? p20-ZG�(.Z".e/L Gal(o U 45�J CITY/STATE/ZIP: , JJJJ 0ek04(e (Lh 9co-O�P CEL NUMBER: • OWNER: , A ,�1J��2 L PHONE NUMBER: (/( (r "" L/(1 3 MAILING ADDRESS: f09(q ' „6�2C,,1G+�c1? � �;�_A 1,t1e l UL (Street) `(City/State) (Zip) CONTRACTOR:2a a Z(f 4 2( LICENSE NUMBER: - 3 704)/ PHONE NUMBER: (A // 7 U X 3 9' MAILING ADDRESS: f) l� $ '7© II (Zt , (/q,DO-CD (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 = /,; •oO HEATING EQUIPMENT +100, 000 BTU x = GAS PIPING (1 - _4. OUTLETS) / x .41-61-6-= 7 ' c2 C) GAS PI4ING (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 $ / 3 C PLUS: PROCESSING FEE + $ 25. 00 EQUALS: TOTAL PERMIT NOTE: MIi I •a •E4. IT FEE IS $35.00 FEE DUE _ $ SIGNATURE ado, 1st�R' _ /_ ! _/ I di Spoka e Ci fdty Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 PAY T•_/ �1_�1 Y6�•, I. „fa, _ I INVOICE RECAP AND DISBURSEMENT VOUCHER No. 463540 STORE NO. STORE \666ukcp_k_e_ DATE SALESCHECK JOB I.D.NO.OR A 1OUNT ALLOCATION OF EXPENSE—FOR INSTALLATION OFFICE USE CUSTOMER'S NAME DUE ACCOUNT DIV. CONTRACTOR MEMO NUMBER WORK ORDER NO. CONTRACTOR NUMBER NO. ADJUSTMENT ACCT. ACCT. EXPENSE SELLING 3,1a1 '7 ?-.7! (to I cer ifVtU the Ins allations listed above have all been TOTAL completed satisfactorily in accordance with the speci AMOUNT C°f TOTALS fications furnished me. — 36 OK TO PAY PAYING UNIT NO. a 01 "7 �) (AUTHORIZED SIGNATURE) - CHECK NO. I PAYING (CONTRACTOR'S SIGNATURE) ( )TATE UNIT NAME) (If Different) 14489(See Bul.0-187 Part II Supp.8) REV.3/91 SEARS FORMS MANAGEMENT ACCOUNTING COPY