HomeMy WebLinkAbout9402-21PER~'IIT APPLIGATLOi~
City of Port Townsend, Washington. 98368 Phone: (206)385-7609 Fax(206)385-4290
APPLIG9IVT: ~ OWNER ~ CONTRACTOR ~ OTHER
COMMENTS: PERMIT ~ ~ ~C °~ - °~-~
sITEADDRESS: j ~ 5~ C-~r„ti~,. Sf.
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OWNER-PHONE
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ADDRESS:
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E~Q'IRATION DAT vim... ... ~ _ _ ,
CONTRACTOR PH
NE}~ TYPE OF E UIPMENT = :FEE:: NQ, i TYPE [1F FDtTURE ~,~<
RANGE WATER CLOSET ,~O
WOOD/PELLET STOVE BATHTUB
GAS FURNACE btx is LAVATORY
~ CONViRSION BURNER btsr9: SHOWER
UNIT' HEATER bee i• KITCHEN SINK gd
BOILER btr~i: DISHWASHER
GAS PIPING I LAUNDRY TRAY
EVAPORATION COOLERS bru'r: CLOTHES WASHER
AC UNIT bru% WATER HEATER
HEAT PUMP brrr% URINAL
! REHE\T BOX brn's: I I DRINKING FOUNTAIN
AIR HANDLING UNIT brn s: I I I FLOOR SINK OR DRAIN
EXHAUST F.Ai~IS f SLOP SINK
RA.'VGE HOOD (residcncial) ~, I WATER PSPIING & ALTERATION ~
RAAiGE HOOD (commercial) I GREASE TRAP/INTERCEPTOR ~
I CLOTHES DRYER HOSE BIBBS I
INCINERATOR ( \Q` I LAWN SPRINKLER SYSTEM
DUCT ALTERATION I SWIMMING POOL
TANKS e: C ~ I BLDG. SEWER (mobile /moved house)
REFRIGERATION UNIT ROOF DRAINS
OTHER OTHER
MECHANICAL PERMIT FEE PLUMBING PERMIT FEE - ~
_ __
(010.322.100.00) Mechanical Fees
(010.386.102.00) State Fee
TOTAL,
APPLICANT S SIGNATURE:___Ld~•____~
~~
$ t
Balance Due Fees Received by Deputy-Clerk
Plumbing Fees
State Fee
TOTAL
~~
ST
Date Recd Receipt No.