2003, 11-04 Permit App: BLD-03-02970 Plumbingor . 000"*�
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PLUMBING FIYTUV.C-c
BANKCARD NUMBER:
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,
X
$6
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X -RAY, FOOD,
PREP /CULINARY /MEAT
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,
$6
CONDENSATE
X
=
12
FOUNTAINS, DRINKING
X
$6
=
13
WATER PIPING /DRAIN -IN
INSTALLATION, ALTERATION,
X
$6
WASTE, VENT,
REPAIR, REVERSALS
PLUMBING REVERSAL
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
VACUUM BREAKER, CHECK
X
$6
DEVICE
VALVE, AND R.P.B.P.D. FOR:
VATS, SUMPS, TANKS, BOILERS
17
SPRINKLER SYSTEM
X
$25
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
$5
CHEMICAL HOLDING TANK
X
=
L201MISC
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
=
PLUMBING FIXTURE
X
$6
=
SUBTOTAL
❑ CASH p CHECK p . ❑ __..______
PLUS PROCESSING
$35.00
FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT
OF A MAJOR CREDIT CARD
FEE
TOTAL PERMIT FEE
DATE: FxnrR Fc.
DUE
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: