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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)