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2003, 10-27 Permit App: BLD-03-02907 Plumbing ReversaldTti OF ane "ley PLUMBING PERMIT APPLICATION PROJECT<1PERMIT ADDRESS: �lO 1 1 Qw� ;gl"-..\ DETAILS # OF wanX USE: OWNER: EQUALS AMOUNT 1 TOILETS PHONE (Daytime Contact): MAILING ADDRESS: X $6 = 2 (street) (city/state) (zip) CONTRACTOR: D, Coin z.�-N.Q., = 3 TUBS LICENSE #: d'©LARe,c.ik 1 S l ki (w X MAILING ADDRESS: l qg t8' g, s'e ua- GI fi ,mss PHONE #: 607 94a,L -Egs tea- 9901 X (street) = (city/state) (zip) PLUM8INC FIXTURES BANRCARD NUMBER: AUTHORIZED SIGNATURE: DESCRIPTION DETAILS # OF wanX COST EQUALS AMOUNT 1 TOILETS WATER CLOSET, BIDETS X $6 = 2 URINALSX $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 i X $6 = 14 SEWAGE EJECTOR GRINDER, SUMP PUMP X $6 = 15 WATER USING DEVICE ICE AND/OR COFFEE MAKER, HOSE BIB, STEAMER, PROOFER, CARBONATOR, SWAMP COOLER X $6 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 X $6 = 19 MEDICAL GAS per outlet NITROUS, OXYGEN X $6 = 20 MISC PLUMBING FIXTURE X $6 = - SUBTOTAL IIIIIIIIIIII _-.-1 VISA . al., • CASH • CHECK • IIIIIMIN • .__.-_=': PLUS PROCESSING FEE $35.00 FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT OF A MAJOR CREDIT CARD TOTAL PERMIT FEE DUE BANRCARD NUMBER: AUTHORIZED SIGNATURE: