HomeMy WebLinkAbout9403-04Z `~
City of Port To'
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PERI~II'T APPLIGATIOi~
send, Washington .98368 Phones' (206)385-7609.' Fax: '.(206)385-4290
APPLICAI`3T: ~ OWNER ~ CONTRACTOR ~ OTHER:
~ ~' 963 - a
t. ~ -tr+,~~ ~f nI ! `1~ '~'~,t2~. PERMIT ~
SITE AD
OWNER: v c •~
CONTRACT OR:
CONTRACI~OR LICENSE ~ ~J Q
OWNER PHONE;< ~ ~~ ~ y
r~zo~ ~'
CONTRACTOR PHONE
1V0:. .. ' .. TYPE OF E 'L7IP1~tEti'T .. i FEE NO. .TYPE CIEGFIXTI3RE ~ ,~: E1LE:
'RANGE - WATER CLOSET
woon~PELLET srovE
GAS FURNACE bra's: ~T~B
LAVATORY
COi+i't~eRSION BURNER ben is SHOWER
UNIT HEATER ben'r: KITCHEN SINK
BOILER brn is DISHWASHER
GAS PIPING I LAUNDRY TRAY
EVAPORATION COOLERS bra is
AC UNIT be:<k
I I CLOTHES WASHER I
WATER HEATER
HEAT PUMP bra's: rurv: URINAL
REHEAT BOX bra's: I I DRINKING FOUNTAIN
AIR HANDLING UNIT bsn S: 5 ~ Fi.00R SINK OR DRAIN
I EXHAUST FA~~IS P ~ SLOP SINK I
I RA,*IG£ HOOD (residential) I WATER PIPi1NG & ALTERATION I
I RAPIGE HOOD (commercial) ~ GREASE TRAP/INTERCEPTOR
CLOTHES DRYER HOSE BIBBS
INCINERATOR ~ O LAWN SPRINKLER SYSTEM
DUCT' ALTERATION V \ SWIMMING POOL I
TANKS e: O ~ ~ I BLDG. SEWER (mobile / movcd house)
REFRIGERATION UNIT \ I I ROOF DRAINS
OTHER: OTHER
MECHANICAL PERMIT FEE / 9-r? PLUMBING PERMIT FEE
1010.322.100.00) Mechanical Fees ~ . ~~ Plumbing Fees
(086.102.00); State Fee - Sa State Fee
TOTAL ~~ `~,, ~/ (' ~ ~ {TOTAL
APPLICANT'S SIGNATURE: /lc/`~" ""•~~!'
a~~ _ ,~:_
$- ~.
Balance Due Fees Received by Deputy-Clerk
ADDRESS:
~CPIRATION DATE: