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Home My WebLink AboutBROAD ST., 134 ,- .., ,0." -',;i""","$ilt'~Ji;''''' _.i"'" - 1.... ,r~7,'~"'_'fr>:l';;"i,~,*;V;')ji";"-."-C""'{""""',,,",,"j':"'1"";-!"1''''f;i1.'''~ ,- , ,-'~ PERMIT i,' "":,,,,. "f. ..<t CITY 0' REMEHTON BUILDING, DEPARTMEN;:-' 134, Broad ";> PHONE:478-5281 JOB ADDRESS Brown 13-'1 Broad St~: BrEimel"'ton OWNER MAl D;:'\DDRESS ZIP PHONE Pluel J:> ~()(l Bot 887 B:r.'emerton $ Washington tW4,-2666 CONTRACTOR MAl L ADDRESS PHONE LICENSE NO. Class of work: o NEW o ADDITION o ALTERATION o REPAIR Q MECHANICAL D PLUMBING s CHIMNEY (No fee information only) INSPECTION: Groundwork Gas Test Masonary Lines Unlined Wasted Vents Water Factory Mfg Type B Type L Htg. Ruffin Chimney Location: Internal Outside Wall Stove or Insert Refrig. No. Type of Equipment F,e No. Type of Fixture or Item Fee -- -- STOVES Gas_ Oil_ Wood_ -- WATER CLOSET (TOILET) -- FIREPLACE INSERT -- BATHTUB -- FURNACE Gas (Nat.~ LPG. _) Oil_ LAVATORY (WASH BASIN) -- Wood add on _ Other_ Electric_ SHOWER -- BTU 82~OOO KITCHEN SINK & DISP. -- Type: Up'flow_ Down flow_ DISHWASHER -- Horizontal X Wall_ €5 00 LAUNDRY TRAY -- -- CONVERSION BURN~R: Gas_(Nat._ LP_) CLOTHES WASHER -- Under 100,000_ Over 100,000_ WATER HEATER -- Oi~ -- URINAL -- UNIT HEATERS BTU_ Gas_ Elec._ -- DRINKING FOUNTAIN -- BOILER Gas_ Oil_ Electric_ FLOOR - SINK OR DRAIN -- Ot,her_ HP_ -- SLOP SINK -- GAS SYSTEM Max. 5 outlet Total_ --1L ~ WATER PIPING & TREATING EQUIP. -- EVAPORATION COOLERS Roof_ Wall_ WASTE INTERCEPTER (Grease) -- BTU_ -- VACUUM BREAKERS & BACKFLOW DEVICE -- AC UNIT Electric_ Gas Elec. Combo LAWN SPRINKLER SYSTEM -- BTU_ -- SWIMMING POOL - Private Public -- HEAT PUMP Single Package_ SpliL- GROUNDWORK -- Add on_ BTU Ton_ -- SUMP ~AC( -- MIXING OR REHEAT BOX CFM_ BTU_ ALTERATION jl,. / -- AIR HANDLING UNIT CFM_ BTU_ -- POST & BEAM ~7~~~)' -- FANS ExhausL- Supply_ Bath_ -- RANGE HOOD Residential_ Comm._ V' PERMIT$~_ CLOTHES DRYER Res._ Comm._ -- TOTAL$__ Incinerator -- NOTICE ALTERATION TO DUCT SYSTEM .THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR- Heating/Cooling_ ExhausL- -- IZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS TANKS Oil_ Gas_ Propane wlOK SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT At'!Y TIME' AFTER from Fire Dept.~ Gallons_ WORK IS COMMENCED. -- REFRIGERATION UNIT I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND -- KNOW tHE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS GFLAWS AND 1''' 50 ORDINANCES GOVERNING THIS TYPE OF WORK WILLEjECOMPLlED WIT!-l WHE- PERMIT $ 0 THER SPECIFIED HEREIN OR NOT. THE GRANtiNG OF A PERMIT DOES NOT PRE- TOTAL FEE $ :U5 50 S'UME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY -- OTHER STATEOR LOCAL LAW REGULATING CONSTRuc:nON OR THE PERFOR- MANCE OF CONSTRUCTION. " 1:::A :::~:~L-'-'.j _j'J/:t,l~l;{:T.>~~,~.::) 9/""('/8" '\>' ~.) ~ ....:t SIGNA TURE OF CONTRACTOR OR AUTHORIZED AGENT (DA TE) FINAL APPROVAL SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) (SEE OTHER SIDE) RECEI PT NO. PERMIT NO. ~I(J t)~~Q9 f..Jt 4-" (White-ORIGINAL, Yellow-INSPECTOR, Pink'APPLicANt) , , . : . ...: .--___f- ~, . CITY OF BREMERTON POSTING MEMO FOR REFUNDS , /h r;-u ::::~ received as-J)tJl(~ It]! 7-/::t}'ar-"' The amount of, is to be refunded to: SII /(,U I C if I~~ (d_s.~r- --_Go~f2 ------- __\dQ....:_-.B_"f~L~_.L_____J3.R Lf, ~_!-LU !-1Y7 -- ~-----,--,-----"._---_._----,- as a result of __,__J 0 .13____, " \2. 13- Pu tV 0 D~ IN COu.-v 'Fly - -' _Yt.S1Z-- M _LL F~--~ ----,---- I - Date and number of original Treasurer's Receipt (if applicable) 73Z?-j - -----..., Fund affected:,__ Revenue Account to be debited _____"___ Cash Account to be credited .-'" CITY AUDlTOR--------- -- SUPERVISOR Paid by Treasurer's Check # dated______ cTiy-Treasurer --.- Posted to applicable accounts: , Account Clerk "lf1M"130 lYPl ,~,," -""-"'."'~-'~ . ,. -------cpE R M IT ' APR'tICA'l']ON' : CITY eREMERTON BUILDING o'EPARTMEre I ~LJ. pctOAro ~T.' PHONE: 478-5281 "~-""'-"~-'-'~"-------~--"---"""'''''''''-'''--------~--",--_.,,--,.,-~-"...------~.~.~...-'-.,-_.~____.M_~_______._...~ .JOB AOOHESS __.-Iff. N_..,,~ Rg_~d__________L~.'-I,____1? IZ_~~~___ ~ ~__._~~~'!'_~,!!.!.~~_______.____.__,.___________.____ , OWNER MAIL ADDRESS ZIP PHONE __._~_~~ v..!.g~__E~_fc.~.___..,,__tQ~_~O~___<J, Cjs.l_~,,~~.!- (l ~_'::!..__.,__~_7 't:..,~~_~ ~__,_.___,___.__.__.._._ CONTRACTOR MAiL ADDRESS PHONE LICENSE NO. -'-'-"~~--~--~'."-"'_._---'~~-"--'--'~-"._~----~-'-"'_..-'------'---'-----_._-,-~--_.._--------_.._----,-------,,------------------- .----,----- Class of work: o NEW o ADDITiON .,t ALTERATION o f,EPAIR ------ """"'......... T -_ ...... - - ---..--.---- ............. ".- .. "'-. ~ MECHANICAL D Pl.UMBING ..""'..._-_._~-------.._- ...-.. .-- CHIMII.IEY (No fee inlormation only) INSPECTION: Groundwork __,..,_____,_____ Gas Test __,_...___. . Masonary Lines __,_______..___,___,_., Unlined_.__.__._..__.,_______ Wasted Vents ___________ Water __ Factory MIg Type, El______...._______.Typ<l L ...._,__,_.______._______ Htg. Ruffin _.... _, Chimney _______ Location: Internal__ ,__...'" ".___._,__, 01Jt.~ ide Wall_._.___,_,...,_ Stove or Insert_.__, -----.---.-- -!J~__.__----IrP-i~f FiK!l;!!6 or Ue_~___.___ __._..!...'j(1l _1 STOVES Gas___.". CliL._ Wood.,_._ ---- --.... \MATER CLOSET (TOILET) ----, FIREPLACe INSERT "'..._~~,'- BATHTUB ----~ FURNACE Gas (Nat;(.__ LPG. ,---i Oil..__ .:~~ LAVATORY (WASH BASIN) ~--_. , VI/ood add on _......., Other,,,,_,_.,_ EleGtric.",,__.,.. SHOWER --'-, BTU g 2, 000 KITCHEN SINK 8- OISP. -~-'- Type:-!Jp Ilow__.,,_. Down flow",.___.,. ~~ DISHWASHER ..-----. HomontaLK. I"'all...___ LAUNDRY TRAY ._-~--- CONVERSION BURNER: LP__,___) CLOTHES WASHER =-1 Underl 00,000__,_..__ O\ler 100,000____ WATER HEATER OiL_.,_.., ---- URINAL .....--.- UNIT HEATERS BiU_,..._.._ Gas..__,.., Elec._.,__.._"" --.....-...- DRINKING FOUNTAIN ---'------ BOilER GaoL,..,,__ OiL"._ Electric____,__. FLOOR. SINK OR DRAIN -----, Olher,__ H i~,_._._ --~ ---- SLOP SINK -- --- GAS SYSTEM Max. 5 outlet TotaL___,. -$-- -~- WATER PIPING & TREATING EQUiP. --- EVAPORATION COOlEflS Aoot,..__.,_ Wall..____ WASTE INTEflCEPTER (Grease) ====1 BTLI ......, ---....-- VACUUM BREAKERS & BACKH,OW DEVICE AC UNIT Eleclnc.,,_,.._, Gas Elec, Combo LAWN SPRINKLER SYSTEM ._,~_._... BrlJ.._., -_. SWIMMING POOL. Private Public ---..-.... !-lEAT PUMP Single P(lckage._,. SpIiL_ GROUNDWORK ------ Add on._.._._ B TU T on____,_ ---'-~-- SUMP ~-~-~ MIXING OR REHEAT BOX CFM...,,__ 8TI),._" ALTERATION ---,- Am HANDLING UNIT CFM..__.,'_ BILI_.",_.,.. --- -_.- POST f:t BEAM ---.....- FANS Exhaust_._",_ Supply..._.__, Barh,._.."._., ---~ HANGE HOOD Resid€!!1tial___ Comm, ,..,_., PERMIT $ _._'__ CLOTHES DRYER Res.____,___ (o,;"m..,_.,_,. --_._--- TOTAL $-.-__----1 Incineratm -----. --~ NOTICE ALTERATiOll'l TO DUCT SYSTEM THIS PERMIT BECOMES NULL AND VOiD IF WORK OR CONSTRUCTION AUTHOH. Heating/CO,Jling..,.__.._.. Exhllust.._..,_ -....-- ---- IZED is NOT COMMENCED WITHIN 120 DA YS, OR IF CONSTRUCTION OR WORK is TANKS Oit',.__.. GaL,_.__ Propane w/OK SUSPENDED OR ABANDONED FOR A PEFlIOD OF 120 DAYS AT ANY TiME AFTER from Fire Dl;iP1.,_,_,~ Gallons_.__ WORK IS COMMENCED. ___.~M'_ REfRIGERATIONl UNIT I HEREBY CEfITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND -...-....- KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISiONS OF LAWS AND ~ 5D ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHE- PERMiT $ THER SPECIFIED HEREiN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRE- TOTAL FEE $ ~K~ SUME TO GIVE AUTHORITY TO ViOLATE OR CANCEL THE PROVISIONS OF ANY OTHER ST,ATE DB LOCAL LAW REGULATING CONSTRUCTION OR THE PEAFOR- MALiZ CONSTRUCl'ON, ,-- .~~M~ 9- z,G.' 8cf SIGNA TURf OF CONTRACTOR OR AUTHORIZED AGENT (DA 7E) iN A L ,r;, P PRO V A L ..__.._...____'_..___._.__......,.___........_.__..___,__.____.._..__._.,__.. OF ,oINNER (IF OINNEfl BUILDPIlI m,~TFj (SEE OTHER DE) RECEIPT NO. '-------,-.,-___,__._,.,_. PEHMIT N( .Of{IGlNAL, Yllllo\/HNSI'ECrOR, Pink-APPLICANT) t,: ~~ ~