1992, 11-30 Permit App 92010454 Mechanical-Voidl��) �o O j MtUHANIUAL rtHIVH! A�'YLWAEIUN FORM
Ir. formation Worksheet , a-/Q
JOB STREET ADDRESS: '% r/ �7 IOC �`���� 3'j
CITY/STATE/ZIP: (2',k7:/0 -PARCEL NUMBER:
OWNER . ,Y, / //%i Y 2J 7 PHONE NUMBER: 9- -7 - (749',/
MAILING ADDRESS:
(Street) /(City/State) (Zip)
CONTRACTOR: ,4 Q� ..Q&11� LICENSE NUMBER: -42 -
PHONE NUMBER:
MAILING ADDRESS: Yc=) "5_7O -7
(Street)
misminamimmujim
MECHANICAL WORKSHEET/FEE
DESCRIPTION
• r.
City/State) (Zip)
SCHEDULE
NUMBER X EACH
OF UNITS UNIT
= AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 ETU
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
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS _
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. 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 <10,0.00 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 =
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 =
,07
/�UO
NOTE:
SIGNATURE
L
IS $3,Sj.00
`7Z
SUBTOTAL
PLUS: PROCESSING
FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
Spokane CodDepartment of Building and Safety •
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
PAY TO
e� f I VOICE RECAP AND DISBURSEMENT VOUCHER
STORE NO.07>
STORE �1,'n- �Le—
No. 742593
DATE /7r/�
CUSTOMER'S NAME
SALF.SCHECI(
NUMBER
JOB LD. 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
4St? /r - 77
is-C °107
-
CI
/C5
257 7"E ` 71A-za -
�0
a()
J
�
_
eT
4 "azi n it --
I certify that the installations listed above have all been
completed satisfactorily in accordance with the speci
fications furnished me.
TOTAL
AMOUNT
���
T
TOTALS
tr
OK TO PAY
PAYING UNIT NO
/�/ 7
7
(CONTRACTOR'S SIGNATURE)
CHECK NO
(AUTHORIZED SIGNATURE)
(DATE)
PAYING
UNIT NAME
(If Different)
14489 (See Elul. 0-167 Part II Stipp. 8) REV. 3/91 SEARS FORMS MANAGEMENT
ACCOUNTING COPY