1991, 11-27 Permit App: 91008259 Mechanical Fixtures Q45 '61 5 '6 - O a 0 Co MECHANICAL PERMIT APPLICATION FORM 60
'v\eX61,,, P � �'� Ir.formation,WorksheetJOB STREET ADDRESS: ,2 / n'' 1-e
'7(r) --2D (. 9/p hz2 �( > b • 3610
CITY/STATE/ZIP: i ct.9491 PARCEL NUMBER:
OWNER: ;� .• // PHONE NUMBER: 3�-- L/
MAILING ADDRESS x /7() 3 (19etJz .z- -- i/)aai,i,if /-)71 q 9 /c
(Street) (City/State) (Zip)
CONTRACTOR: L(L1 ' vim-- LICENSE NUMBER: .SE - 4/2 -.5l2 - 3 7g
n PHONE NUMBER: �/�'� -/ ( -26 se 34'9
MAILING ADDRESS: Po i 3n0 -7 ifi , (1)74q,9- 0
(Street) ( HState) (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 = /a 00
HEATING EQUIPMENT +100,000 BTU x =
GAS PIPING (1 - _4 OUTLETS) /, x .4 -&6--= / # CO
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
NOTE: MINIM• : 1 FEE IS $35.00 FEE DUE = $
SIGNATURE h ��...� e &O
Spokan • CoutitY Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
PAY T a s I rVU1L t I'SCi..Hr HAIL! LJIDDISUrsat!VICINI VVUl.nCIS
A v,. t � 5� .t No. 543008
STORE NO. 1671J
STORE 41 , DATE 1/
-, F97
-
SALESCHECK JOB I.D.N0.OR AMOUNT ALLOCATION OF EXPENSE—FOR INSTALLATION OFFICE USE
CUSTOMER'S NAME NUMBER WORK ORDER NO. DUE ACCOUNT DIV. CONTRACTOR MEMO
CONTRACTOR NUMBER NO. ADJUSTMENT ACCT. ACCT. EXPENSE SELLING
I-' i i^ IC/ fi�y3.�:::127-.: �ri 't`�� :::4c;.. :'
: C
,L,06-11 cy e..44410,62 _ 1 .0... ... •,. ,.. ..,) .• 04 $4.0 4'.'1', ) 1
.- I ••• 49• •I 1 U• •Y.
TRANSACTION CODES SEARS `_,•^ •S.•. 1.i _ ^. 1..Viii
DETACH BEFORE DEPOSITING ; •
1.REGULAR INVOICE 8.FREIGHT REMITTANCE ADVICE �• . r -'
2. OUR MEMO BILLS ISN•. v •epi:O• �N•ui• •v•"•o-
3. YOUR MEMO 9.FRT CUT r '•� •,-, •' , •� �� Y• ,
4.RETURNED GOODS DOWN IF THIS REMITTANCE APPEARS TO BE INCORRECT -� •''"ticiRi;• .•, •T",tIR..1R'
5.ERROR ON INVOICE 1613902 -,"-'„ �-,"-','. {_ •�
6.TRANSPORTATION CHARGES WRITE AT ONCE TO SEARS UNIT PRINTED BELOW i •\\ .-.• •I c ` .-.• •• .k
7. YOUR LETTER OR BAL.DUE :t'� fi iC•�"}�'• '�
INV.DATE INVOICE NO. AMOUNT SUPPLEMENTAL INFORMATION • • _•±/a• " • .•r '._ .• �:
__ `' MO. DAV VR. `1 .� ��=i ` ,J •i •� {_ !�
" 1 12191543008 3800R• PEARSON ^f i <
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SP JK ANE- HIPS, WA 0040791 �+ "' r
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FORM R&D REV.(8-91) -4*.:T=•„ -le" ".'.!., '•
1 1 /22/91 1 OF t I 65892)9 I 1 38100 :WWITeirrtrti
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DATE PAGE NO. CHECK NUMBER _ CHECK AMOUNT DUNS NO.(OR VENDOR NO.1 !
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S_. 1 . , . ..w . ,"_..,Itis .
I certify that the installations listed above have all been TOTAL .$".4q4.`11,4!.:z...- ...c4 =�"`�'
completed satisfactorily in accordance with the speci AMOUNT _ TOTALS •r `• •i -•:: ��"
fications furnished me.
1”
PAYING UNIT NO. �r`;• /f/ Jj 3) �)
OK TO PAY f V
(AUTHORIZED SIGNATURE)
PAYING
CHECK NO. .'/-':„:>//
T / UNIT NAME
(CONTRACTOR'S SIGNATURE) (DATE) (If Different)
14489(See Bul.0-187 Part II Supp.8) REV.3/91 SEARS FORMS MANAGEMENT
CONTRACTOR'S FILE COPY