1993, 01-14 Permit App: 93000200 Water Heater, Piping MECHANICAL PERMIT APPLICATION FOR"
frfoniation Worksheet 5 2 CO
JOB STREET ADDRESS: 7 '7 ( „/� .7}I 0"ex 2 23712-
CITY/STATE/ZIP: ! a 7 / - r PARCEL NUMBER:
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OWNER: ij ii��(� �(�9(a n (2 PHONE NUMBER: f /.r _ m`9 0
MAILING ADDRESS: L/7/I \:)rQ_ 'f_et .4/-�, to C 2,) �
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(Street) City/State) (Zip)
CONTRACTOR4...0_16,171___„:::1(1-_4,? tr,1--- LICENSE NUMBER:3 -412 5k_•
PHONE NUMBER: qqS
MAILING ADDRESS: PC. �d ) C � /61 99t90.0
(Street) City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMDESCRIPTION I
OF UNITS ER I xUNITACH� + = 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 ETU
GAS PIPING (1 -4 OUTLETS) l x 1 =
/` a s
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 <10,0.00 CFM x 12 . 00 =
AIR HANDLER >10,000 CFM x 15. 00 =
SUBTOTAL $ //. OZ.
PLUS: PROCESSING FEE + $ 25. 00
f
EQUALS: TOTAL PERMIT^
NOTE, M MRM •E•+°� E IS S,35.00 FEE DUE = $ 3(�,
SIGNATU- .'�lL�11�r .�"I�� 7"1. , i .
v Spokane Cou i epartment of Building and Safety •
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
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/ �/ pJgVOICE RECAP AND DISBURSEMENT VOUCHER n' g ry Q
PAY TO ��0 A-"` -/ - , �. I . No. / L4'w7
STORE NO. 71)19
STORE_} A.0' &4 ,1 DATE /o; --..4-9o-o- 1
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CUSTOMER'S NAME AMOUNT ALLOCATION OF EXPENSE-FOR INSTALLATION OFFICE USE
SALESCHECK 1 JOB I.D.NO.OR DUE ACCOUNT DIV. CONTRACTOR MEMO
_ NUMBER WORK ORDER NO. CONTRACTOR NUMBER NO. I ADJUSTMENT ACCT. ACCT. EXPENSE SELLING
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I certify that the installations listed above have all been TOTAL 1 �-
completed satisfactorily in accordance with the speci AMOUNT j�, � TOTALS �C� , O/
fications furnished me.11
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OK TO PAY PAYING UNIT NO. �7r
(AUTHORIZED SIGNATURE) T
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