1993, 01-14 Permit App: 93000202 Mechanical Fixtures IYICGI"IAIYILJML rC14wyu i 1u'rLJUJ U iuN rum
Irforiation Worksheet g3 . 2o2 -2(6)
JOB STREET ADDRESS: t SP 7 , 2, 31 t
CITY/STATE/ZIP: , ' ..ilp/ `th 9R/0 PARCEL NUMBER:
•
OWNER: , tif O/k , PHONE NUMBER: ga - 7 70
MAILING ADDRESS: l ' '7 L-7 ),Z '>c dJ iauea t zz4i 99
,24
(Street) (City/State) (Zip)
CONTRACTOR iStalei Aattifr- LICENSE NUMBER: $ -,I2 - 5 - 37 UJT
,n PHONE NUMBER: 1/8)
MAILING ADDRESS: t' L.f 6 37 o`7 1,624 99.
(Street) tate
Ct it
( Y/ ) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
I 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 =
HEATING EQUIPMENT +100, 000 BTU x 1)419 =
GAS PIPING (1 - -4 OUTLETS) ( x -4-r8-6-= er 0
GAS PI4ING (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 = /0 , o0
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 $ //. a6
PLUS: PROCESSING FEE + $ 25. 00
EQUALS: TOTAL PERMIT
NOTE: IMJr,* ""IT FE S $35.00 FEE DUE $
SIGNATURI /f�j - etS#
Spok• ne' un Department of Buildingand Safety .
West 1303 Broadway Avenue Spokane , WA 99260 (509) 456-3675
INVOICE AND INSTALLER RECAP SHEET
INSTALLER
' x._./...„1
Q
s 1 1 i
‘Il NV in_l_u 1
,
If the
number
selling
dollar
to the
TOTAL
INVOICE
COST
OF COLUMNS 7-13)
4
1 V ni in,1 i OLIO
AND THE CERTIFICATE
Installation office
is different than
unit number, the
amount is to be atm'd
selling unit.
TOTAL
LABOR
SELL
5
L/C IfIL - LHDIJtI
OF
INSTALLATION
unit
the
total
TOTAL
LABOR
M/U%
6
rrsiulivu
COMPLETION
OFFICE
SELLING
SOLD
LABOR
7
vvviH \fltt I,
- TO THIS RECAP)
UNIT NO.
UNIT NO.
DIV. NO.
UNSOLD LABOR
DUE TO
PRODUCT ERROR
8
V/AIVtti ur LItN,
INVOICE
#
15 6 7 4 8
AMOUNT
.9t
$NOTE:
11
PAGE
DATE
OF
/ -9/9
/�
7
UNSOLD LABOR
DUE TO
INSTALL ERROR
9
COST
UNSOLD LABOR
DUE TO
ALL OTHER ERRORS
10
FED. I.D.#
CUSTOMER NAME
1
FOCIS
DONE
✓
2
WORKORDER OR
SALESCHECK N0.
3
(TOTAL
12
13
/;?'(77 /Q..2e ,t,:
9 � y-%/
7)O,e )lat7,d_,
-"ay- IIIb
r
TOTAL
,/,,,/,,.--
$ /�
f
$ 36
}.. %
$ •' x,� er
$
$
$
$
$
$
k-- /
ACCT.
ACCT.
ACCT.
ACCT.
ACCT.
ACCT.
ACCT.
APPROVAL (MGR. SIGNATURE) DA
187-04-000
103-00-012
187-08-000
103-00-000
14613(2/91) Rev. 9/91
Sears Forms Management
INSTALLATION OFFICE