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1992, 07-17 Permit App: 92005431 Mechanical Fixtures�3. b51a �-ia MECHANICAL PERMIT APPLICATION FORM�z' L4rj H V LV u�J g, �y Irforraticn Worksheet JOB STREET ADDRESS: //Zzg �� CITY/STATE/ZIP�/nyI nn / j/^- PARCEL NUMBER: oWNER:r, .Y'I.�fi lM�VYlid�n.< PHONE NUMBER: MAILING ADDRESS. 11I I rl rC/-�-� - - (ZIP) (street) .City/S`ate) {Zip) CONTRACTOR:,�o/�� LICENSE NUMBER: S�`Ale-SG2-�7a/1JT /� �( PHONE NUMBER: �Ig a-J�COS� MAILING ADDRESS: PO 4 / Z3`� O `1 C/rnat-Vl/ A�rt a �GC�+44�9_�Q (Street) City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION l OMPTS I 'UNIT" I AMOUNT DUCTWORK SYSTEM- - - - - - - - - - - - - WOODSTOVE/INSERT - _ _ _ - _ - - - - - - GAS WATER HEATER - _ _ _ _ - - - - - - - HEATING EQUIPMENT <100,000 BTU _ - - _ _ - HEATING EQUIPMENT +100,000 BTU _ - _ _ _ 1 GAS PIPING (1 -A OUTLETS) - - - - _ _ _ GAS PIING (5 OR MORE. EACH:)_ - - - _ - REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) REFRIG 101-SOOM BTU- _ _ - _ _ - - - - - REFRIG 501-1,000M BTU- - - _ _ _ _ _ _ REFRIG 1,001-1,750M BTU- - - _ - - _ _ REFRIG +1,750M BTU-__ _ - - - - -- HEAT PUMP & AIR CONDITIONER 0-3 TONS _ HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT PUMP & AIR CONDITIONER 15-30 TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS R CONDITIONER +50 TONS HEAT PUMP & AS - - VENTILATING FANS _ _ _ _ _ _ _ _ - _ _ - EVAPORATIVE COOLERS _ _ TYPE I HOOD (PER 12' 3R712' ?TN. OF HOOD) _ TYPE II HOOD - - - - - -- - - - - - - - CLOTHES DRYER -- - -- - - -- - - - -- RANGE __ ______ _______ 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 X$10.00 = x 25.00 - x 10.00 = x 12.00 = x 1 x 1.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = Ix x 12.00 =I 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 = SUBTOTAL ;� ao " PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT II//oco NOTE t 1ST FEE IS $35.00 FEE DUE SiGNATU S ok ty Department of Building and Safety enn4�nn wn 99260 (509) 456-3675 AY TOS, "_'�' STORE NO.. [T A STORE O ^ " T No. 780685 CUSTOMER'S NAME SALESCHECK NUMBER JOB I.O. NO. OR 'WORK ORDER NO. AM NT DUE CONTRACTOR ALLOCATION OF EXPENSE— FOR INSTALLATION OFFICE USE ACCOUNT NUMBER DIV. NO. ADJUSTMENT ACCT ACCT CONTRACTOR EXPENSE MEMO SELLING OK TO PAY PAVING UNIT NO.� (AUTHORIZED SIGNATURE) PAVING CHECK NO. (DATE) UNIT NAME In Dfffi ,) 4-A �4 I Certuy mat me mstallatlOns IISteu aoove nave all Dean TOTAL completed satisfactorily in accordance with the sped AMOUNT TOTALS fications furnished me. OK TO PAY PAVING UNIT NO.� (AUTHORIZED SIGNATURE) PAVING CHECK NO. (DATE) UNIT NAME In Dfffi ,) (CONTRACTOR'S SIGNATURE) 1,W891See Bul. 0 18 Par( II SuPP. 81 REV. 3/91 SEARS FORMS MANAGEMENT ACCOUNTING COPY