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2003, 11-07 Permit App: BLD-03-03030 Plumbing Reversal
Sikue 4.0.1P Valley P • PROJECT ADDRESS: /0 go. Li f ,?3 rc 1)e DESCRIPTION PERMIT USE: * OF OMITS OWNER: o• f I e_ COST PHONE (Daytime Contact): ‘;', 8,- q3 1 MAILING ADDRESS: 1 D 2 0 9 e d3vci, A ve • Sp. ari.e 100_, (street) (city/stdte) X (zip) CONTRACTOR: . I-4 •4 3 C .- ot,/ WAu-cr./ O N LICENSE #: 1-1 S C©N **- /P3 Kr MAILING ADDRESS: 11277 g Da-Ite_ Lo y -Spo PHONE #: q‘R — (996i/ Kane_ 1 L,Oa_. $6 .990,7 4 (street) (city/state) - (zip) PLUMING* FIXTURES BANKCARD NUMBER: AUTHORIZED SIGNATURE: DESCRIPTION DETAILS * OF OMITS COST . EQUALS AMOUNT 1 TOILETS ' WATER CLOSET, BIDETS X $6 r. 2 URINALSX • $6 = 3 - TUBS X $6 • 4 SHOWERS (PER TRAP) BATH, STALL, ON-SITE BUILT X as ' 5 SINKS LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY, FOOD, PREP/CULINARY/MEAT X 6 DISHWASHER X . $6 is 7 CLOTHES WASHER X S6 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 a 12 FOUNTAINS, DRINKING X • 13 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING REVERSAL INSTALLATION, ALTERATION, REPAIR, REVERSALS X . 14 SEWAGE EJECTOR GRINDER, SUMP PUMP X $6 - 15 WATER USING DEVICE ICE AND/OR COFFEE MAKER, HOSE BIB, STEAMER, PROOFER, CAFtBONATOR, SWAMP COOLER _ X 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 FIXTUREX $6 • . • 0 CASH 0 CHECK El PA7CED PERMITS • Mk TR. • - • SUBTOTAL --r- .1 0 ---..- PLUS PROCESSING FEE $35.00 WILL ONLY EE ACCEPTED WITh PAYMENT OP A MAJOR auunr CARD . VVIITOce TOTAL PERMIT FEE DUE• BANKCARD NUMBER: AUTHORIZED SIGNATURE: