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1992, 06-17 Permit App: 92004457 Mechanical Fixtures�j51°\� 03L�1 50k mtUHANJUAL rtnixm ArrULPAHum runivn L' to Ir. formation Worksheet oCb�n gc�^ g z , C� JOB STREET ADDRESS: a S CITY/STATE/ZIP:\MG'G.s170-.,A,41>,ll90/lo PARCEL NUMBER: OWNER: PHONE NUMBER: MAILING ADDRES : a.o (Street) (City/State)' (Zip) j CONTRACTOR: e �,� , l /1,22 %Oiler LICENSE NUMBER: ,-�E - l9k - - 3 ^7aK�T PHONE NUMBER:- MAILING UMBER:_MAILING ADDRESS: �0 Ira �� % (Street) (/City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION NUMBER OF UNITS X EACH UNIT = AMOUNT DUCTWORK SYSTEM- - _ - - - - - - - - - WOODSTOVE/INSERT - - - - - _ - - - - - - GAS WATER HEATER _ _ _ _ _ _ _ - - - - - HEATING EQUIPMENT <100,000 BTU - - - - - HEATING EQUIPMENT +100,000 BTU - - - - - GAS PIPING (1 - -4� OUTLETS) - - - - - - - GAS PIING (5 OR MORE. EACH:)- - - - - - REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) REFRIG 101-SOOM BTU_ _ _ _ _ _ _ _ _ _ REFRIG 501-1,000M BTII_ _ - - - - - - - - REFRIG 1,001-1,750M BTU- - - - - - - - - REFRIG +1,750M BTU _ _ _ _ _ _ _ _ _ - - HEAT PUMP & AIR CONDITIONER 0-3 TONS _ _ HEAT PUMP & AIR CONDITIONER 3-15 TONS _ HEAT PUMP & AIR CONDITIONER 15-30 TONS _ HEAT PUMP & AIR CONDITIONER 30-50 TONS _ HEAT PUMP & AIR CONDITIONER +50 TONS _ _ VENTILATING FANS EVAPORATIVE COOLERS__ TYPE I HOOD (PER 12' OR 12' PTN_ OF HOOD) TYPE II HOOD CLOTHES DRYER RANGE_____-_-_--_-_-_-_-_-_-_-_-_-_- GAS LOG_______ _________ MISCELLANEOUS (NOT COVERED ELSEWHERE)- - UNLISTED GAS APPLIANCE <400,000 BTU_ - - UNLISTED GAS APPLIANCE >400,000 BTU- - - USED APPLIANCE <400,000 BTU- - - - - - - USED APPLIANCE >400,000 BTU- - - - - - - AIR HANDLER <10,000 CFM - - - - - - - - AIR HANDLER >10,000 CFM x$10.00 = x 25.00 = x 10.00 = x 12.00 = .; _ x 2�= x x 1.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 10.00 = x 10.00 = x 30.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = % / P -or) i /,Cc � SUBTOTAL $ / �- PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT C2 NOTE: MIIM I FEE IS $35.00 FEE DUE _ $ 38 SIGNATURE A'A Spokan Cou Department of Building and Safefifi�� West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 INVOICE RECAP AND DISBURSEMENT VOUCHER PAY TO STORE NO. STORE S440AL je No. 780897 DATE 62 / / r qgD� CUSTOMER'S NAME S NUMB NUMBERR JOB I.D. NO. WORK ORDER N NO. AMOUNT DUE CONTRACTOR ALLOCATION OF EXPENSE — FOR INSTALLATION OFFICE USE ACCOUNT NUMBER DIV. NO. ADJUSTMENT ACCT. ACCT. CONTRACTOR EXPENSE MEMO SELLING I certlty that the Installations listed above have all been completed satisfactorily in accordance with the speci fications furnished me. (CONTRACTOR'S SIGNATURE) TOTAL AMOUNT TOTALS OK TO PAY CHECK NO. (AUTHORIZED SIGNATURE) (DATE) 14489 (See Bul. 0-187 Part II Supp. 8) REV. 3/91 SEARS FORMS MANAGEMENT A!`!`nl IAITINIr rnoV PAYING UNIT NO. PAYING UNIT NAME (lf Different)