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PERIl~IIT APPLIGAT~OI~I .
City of Port Townsend, Washington 98365 Phone: (206)385-3QO~~ax: E246~385-4294
COMMENTS: PERMIT # `( ~ ~ I '- ~ >l
R ~~ /,! °-~ ~-~ ~ ~ Legal Descri lion: vr~t~tN'~z-'iL~.~~~~- Addition
SiTEADORE55: j ~,~C u~E/ ~ Bloc:;(s) ~• LOt(s) Zone: C~
OWNER: ~-1 CZ~e'Y J .~cQ/) % ,°TZli ADDRESS: ~~~ ~ ~
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CONTRACTOR: !~(~~ f7lb/a5 ~% ~ ~~R`' ADDRESS: : /~~ /~- ~' f~ f-2 l~''~' ~-'7
CONTRACTOR LICENSE A ECPIRATION DATE: `
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OWNER PHONE > - -- CONTRACTOR PHONE x
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NO. TYPE OF:E E3IP1l~Et~tT `j FEE NE?_ ~ TYPE QF ~x~ .PEEN.
I RANGE i WATER CLOSET
i'wGGD%P' ' , S:C~E I I BATHTLiB
I G.+S FUR~iACE bru is
I GUi`~YCtCSt VI`, iiLiuv GR orx~i:
l L~ll I1 L~lT'eR bn. f' I LiVATORY I
{ , i SHOWER ~tv ,
I 1 :CTCHEN $INK ~
~GQ
I BOILER brn's: I i DISHWASHER I
GAS PIPING I I ! L~L'NDRYTRAY I
1 EV.~'ORATION COOLERS bra's: ~ , ! CLOT~-IES WASHER
~ AC L~iIT bra is
)HEAT PUMP bru% Nara:
REHEAT BOX bcrsi: I I WA
I URINAL P(, I
1 i ORiNKING FOL'NTAI: OD I
I A!R HANDLING LINTS bru% I I FLOOR SINK OR DRAIN
I !/Ytj.AU~ I' F.4DIS I E SLOP SINK I
R~.~GE:-fOCD (:esidendal) ~ ~ !WATER PIPIING & ALTERATION 7 00
R.LrGE HOOD (commercial) I I GREASE TRAP/INTERCEPTOR {
CLOTHES DRYER I I }HOSE BIBBS I
j [vCINERATOR I j I LAWN SPRINKLER SYSTEM
I DL'GTAl.TER~TION I ! S~i"IM~SING POOL
} TANKS e: I I j BLDG. SEWER (mobile /moved hove)
I REFRIGERATION UNIT I I I ROOF DRAINS
j OTHER: OTHER:
! MECHauYIGL PER.~fIT FEE I PLUMBING PERMIT FEE 20.00
10.322.100.00)
)10.386.1.02.00)
Mechanical Fees
State Fee
AL
Plumbing Fees ~`f,GO ~ze~'~i ~
State Fee ~/.3Z' ~zO° ~~
TOTAL 3~
1~ATF. !l-l6 - ~~
TOT
• PLICANT'S SIGNATURE:,
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Balance Due Fees Raeived by Deputy-Clerk
Date Recd Receipt No.