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HomeMy WebLinkAbout9411-12City of Port Townsend, Was. APPLIGAT~ON LR'~6R Phnner (2061385-3000 :Fax: f20f}385-42911, APPLICANT: ~ OWNER ~ CONTRACTOR ~ oTHER: ~,7~1 ....~. _n / .. ~-Yl Can . •.-~J1 PF # ~/ 7 ~~' ~ e ~} I Ll~ SITE ADDRESS: ~n~ ~ S~ ~ ll~~) OWNER: i-~D ~ ~LLF~T~ZE~'?y CONTRACTOR ^~1 TT t ~, ~ 1,t TC iid CONTRACTOR LICE:`ISE ~ ~ ~ (~ ~('' G i ~~ C'~ OWNER PHONES ADDRESS: 3535 N~~"~~~lJ ~ ECPIRATION DATE: CONTRACTOR PHONE ;< ?~ ~ ' S bbl 1V0. TYPE OF~E UIP14tErIT - • FEE NO. TYPE flFEIXTURE ,: FED RANGE WATER CLOSET WOODIPELLETSTOVE ~ BATHTUB ~ GAS FURNACE bra's: CON4cRSION BUIL~IER brn r: LAVATORY SHOWER UNIT HEATER btu% KITCHEN SINK BOILER bsrt's: DISHWASHER GAS PIPING LAUNDRY TRAY EVAPORATION COOLERS b '. - _ __~ AC UNIT bru:: RK MUS7 COMPLI --'; Y WITI j CLOTHES WASHER WATER HEATER HEAT PUMP brrri; UA{F!?. .-! 'URINAL ! -- ! REHEAT BOX bra's: _ I DRINKING FOUNTAIN I AIR HANDLING UNIT bas's: - - FLOOR SINK OR DRAIN E)QIAUST FADIS %~ ! SLOP SINK ! RANGE HOOD (residrntial) ~ ! WATER PIPIING & ALTERATION RAtiGE HOOD (commercial) I I GREASE TRAP/INTERCEPTOR _ CLOTHES DRYER - ( ! HOSE BIBBS INCtNERATOR I ~ L4WN SPRINKLER SYSTEM DUCT ALTERATION I SWIMMING POOL TANKS e: ! ! X BLDG. SEWER (mobile ! movcd house) /5,00 REFRIGERATION UNIT ! ROOF DRAINS OTHER: OTHER: MECHANICAL PERMIT FEE PLUMBING PER,btIT FEE 71J,C0 J10.322.100.00) Mechanical Fees 010.386.102.00) State Fee TOTAL APPLICANT'S SIGNATURE:, Plumbing Fees State Fee TOTAL 3,S.av y, sC 3 q, s0 ->;. 11-I8 -~14 -- --- ~9. _ _ _._ $ a Balance Due Fees Received by Deputy-Cleric Date Recd Receipt No.