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2003, 09-03 Permit App: BLD-03-02368 Piping*Mane Val ley PLUMBING PERMIT APPLICATION PROJECT ADDRESS: eis one,_ f?—u& PERMIT USE: DETAILS * OP wars OWNER: 23(2.,c 60 ,r. a_ ea -S ..._ PHONE (Daytime Contact): ev , EQUALS MAILING ADDRESS: L'exrh. e— TOILETS ' (street) (city/state) (zip) CONTRACTOR: 1-4 cfr 3 C,01.)tcw-c-tio 1\J LICENSE #: I -IS CoN 2 URINALSX MAILING ADDRESS: 0'17 PHONE #: ci,2— S396/ Ss = 3 TUBS (street) (city/state) • (zip) PLUMING. FIXTURES BANKCARD NUMBER: AUTHORIZED SIGNATURE: DESCRIPTION DETAILS * OP wars X COST , EQUALS AMOUNT 1 TOILETS ' WATER CLOSET, BIDETS X SS = • 2 URINALSX • Ss = 3 TUBS X = 4 SHOWERS (PER TRAP) BATH, STALL, ON-SITE BUILT X 5 SINKS LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY, FOOD, PREP/CULINARY/MEAT I X : 6 DISHWASHER X • S6 el 7 CLOTHES WASHER X 56 8 GARBAGE DISPOSAL , X ;6 = 9 WATER SOFTENER X in 10 ELEC HOT WATER TANK NOTE: IF GAS SEE MECHANICAL X $6 = 11 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE X 86 = 12 FOUNTAINS, DRINKING X os 13 WATER PIPING/DRAIN-1N WASTE, VENT, PLUMBING REVERSAL INSTALLATION, ALTERATION, REPAIR, REVERSALS 4( X S6 = & . 0 0 14 SEWAGE EJECTOR GRINDER, SUMP PUMP X S6 - 15 WATER USING DEVICE ICE ANO/OR COFFEE MAKER, HOSE BIB, STEAMER, PROOFER, CARBONATOR, SWAMP COOLER X = 16 CROSS CONNECTION DEVICE VACUUM BREAKER, CHECK VALVE, AND R.P.B.P.D. FOR: VATS, SUMPS, TANKS, BOILERS X S6 17 SPRINKLER SYSTEM X $25 18 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK X 86 = 19 MEDICAL GAS per outlet NITROUS, OXYGEN X S6 = 20 MISC PLUMBING FIXTUREX se 0 _ . • • CASH 0 CHECK FAXED PERMITS . _ - . SUBTOTAL . , 0, 1,k164.1 1 0 PLUS PROCESSING FEE $35.00 WILL ONLY BE ACCEPTED WITH PAYMENT , OF A MAJOR. CREDIT CARD TOTAL PERMIT DUE FEE 'V / C° BANKCARD NUMBER: AUTHORIZED SIGNATURE: