2003, 08-08 Permit Application: BLD-03-02174 Plumbing ReversalSMkane
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PLUMBING PERMIT APPLICATION
PROJECT � �� �
ADDRESS: 9 . alk\ L
DESCRIPTION
PERMIT
USE:
# OF UNITS
OWNER:
COST
EQUALS
AMOUNT
PHONE (Daytime Contact):
TOILETS
MAILING ADDRESS:
X
$6
=
(street)
(city /state)
(zip)
CONTRACTOR:
D, C o v , Q L
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=
LICENSE #:
do uR fi,c. Ak 13 l k1
3
MAILING ADDRESS:
1ggIS' g, sie
-
G-Re:e.r/
PHONE #:
$6
mss tea_
99016
4
(street)
(city /state)
(zip)
PLUMBING FIXTURES
BANKCARD NUMBER:
EXPIRES:
AUTHORIZED SIGNATURE:
DESCRIPTION
DETAILS
# OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6
=
2
URINALS
X
$6
=
3
TUBS
X
$6
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON -SITE BUILT
X
$6
=
5
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X -RAY, FOOD,
PREP /CULINARY /MEAT
X
$6
=
6
DISHWASHER
X
$6
=
7
CLOTHES WASHER
X
$6
=
8
GARBAGE DISPOSAL
X
$6
=
9
WATER SOFTENER
X
$6
=
10
ELEC HOT WATER TANK
NOTE: IF GAS SEE MECHANICAL
X
$6
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
$6
=
12
FOUNTAINS, DRINKING
X
$6
=
13
WATER PIPING /DRAIN -IN
WASTE, VENT,
PLUMBING REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
X
$6
=
14
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6
=
15
WATER USING DEVICE
ICE AND /OR COFFEE MAKER,
X
$6
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
16
CROSS CONNECTION
DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D. FOR:
VATS, SUMPS, TANKS, BOILERS
X
$6
=
17
SPRINKLER SYSTEM
X
$25
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
$6
=
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
=
20
MISC PLUMBING FIXTURE
X
$6
=
_—
vI R
SUBTOTAL
•
CASH • CHECK
•
PLUS PROCESSING
FEE
$35.00
FAXED PERMITS
WILL ONLY BE ACCEPTED WITH PAY ?.iEM
OF A MAJOR CREDIT CARD
TOTAL PERMIT FEE
DUE
BANKCARD NUMBER:
EXPIRES:
AUTHORIZED SIGNATURE: