1993, 04-20 Permit App: 93002691 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM arbe /
ItforrQit sign Worksheet
.703 STREET ADDRESS: Q`' [d %i /I"' / 2n.o.AL ,/ ' 9772.
CITY/STATE/Z IP:o/1�J�.lF►�s[Dii 1Y�If0 PARCEL NUMBER:
ore
OWNER:
'MAILING AD
�PHONE NUMBER: 9A242_3( p�i9�Q
�
CRESS : 7X/ /J as- .�. ll *a,iLG/ i
(Street) City/State) (Zip)
CONTRACTOR: flA'x2, A.14/ LICENSE NUMBER: ,_SG` fW S 2SVVT'
PHONE NUMBER: n' .�0
MAILING ADDRESS:
P061370 1��� aio
(Street) (Cit tate) (Zip)
(St )
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS --UNIT
DESCRIPTION
= 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 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
AIR CONDITIONER 0-3 TONS
AIR CONDITIONER 3-15 TONS
AIR CONDITIONER 15-30 TONS
AIR CONDITIONER 30-50 TONS
AIR CONDITIONER +50 TONS
FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER.
RANGE
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
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
l
r
x$10.00 =
x 25.00 =
x 10.00 =
x 122.00 =
x
1.
X -4- - p&
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 50.00 =
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 =
/V . oz,
,or)
7 'co
/2'06
NOTE: `�• PERMIT FEE IS $35.00
SIGNATURE/ !!,PI / J! 61
E S='1"-, e County Department of Building and Safety
We 1.03 Broadway Avenue Spokane, WA 99260 (509) 456-3675
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
. FEE DUE
_. $ 6;0ce:2
PAY TOA 40-""i4. i L 4
INV,OI E RECAPAND DISBURSEMENT VOUCHER
STORE NO.. 4(077
STORE sC1 #
No. 817530
DATE 9— i9 -93
CUSTOMER'S NAME
SALESCHECK
NUMBER
-
JOB I.D. NO. OR
WORK ORDER NO.
AMOUNT
DUE
CONTRACTOR
ALLOCATION OF EXPENSE - FOR INSTALLATION OFFICE USE
ACCOUNT
NUMBER
DIV.
NO.
ADJUSTMENT
ACCT.
ACCT.
CONTRACTOR
EXPENSE
MEMO
SELLING
$4� °,Sit eki21-C4I
s's ai. w
o al'
e
46062-
,1,/
54 idge2drt
.1.
'nee
Ar
d3a
/
Y
I certify that the installations listed above have all been
completed satisfactorily in accordance with the speci
fications furnished me.
TOTAL
AMOUNT
OK TO PAY
TOTALS
(AUTHORIZED SIGNATURE)
CHECK NO.
(CONTRACTOR'S SIGNATURE)
14489 (See Bul. 0-187 Part II Supp. 8) REV. 3/91 SEARS FORMS MANAGEMENT
(DATE)
ACCOUNTING COPY
PAYING UNIT NO 727
PAYING
UNIT NAME
(1! Different)