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2003, 04-09 Permit App: BD03-033 Plumbing Reversal*01(am 4.0#1/2lley PLUMBING PERMIT APPLICATION PROJECT 5 I % , 5 DESCRIPTION PERMIT 0 3 _p 3.$ USE: $ew, t.PVPt50 ,' / ADDRESS: �/�7 1 OWNER: �� /7 11107t`- COST PHONE (Daytime Contact): AMOUNT/ 1 1 r/ /-0,71 MAILING ADDRESS: soya, e 4/a-1 o /�,/� h I X 9Q2� (street) (� , (IEty/state) (zip)902/.7 2 URINALS CONTRALTO • (' 0,177 S LICENSE #: 6/5(1901,/-% ' 72- 3 $6 [^ /— AAILINGADD S: �. </O /����� ,/ 517 _ . 9OIC/.n,o //a /42 [,,/N 99,�Z, PHONE#: 0,26 - Ss9GV / 76 ) X $6 = (stiet) (city/state) (zip) SHOWERS (PER TRAP) BATH, STALL, ON-SITE BUILT PLUMBING FIXTURES BANRCARD NUMBER: AUTHORIZED SIGNATURE: EP A 0 Doi DESCRIPTION DETAILS #OFUNITS X COST EQUALS AMOUNT/ 1 TOILETS WATER CLOSET, BIDETS I X $6 = (.. 2 URINALS X $6 = 3 TUBS X $6 = 4 SHOWERS (PER TRAP) BATH, STALL, ON-SITE BUILT 1 X $6 L 5 SINKS LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY, FOOD, PREP/CULINARY/MEAT X $6 = / (0 6 DISHWASHER X $6 = 7 CLOTHES WASHER X $6 = 6 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 C 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 11-4° C ' =ZY_ VISA• Ma ❑ cam{ 0 CHECK II. PLUS PROCESSING FEE $35.00 FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT OFA MAJOR CREDIT CARD TOTAL PERMIT FEE DUE 5-9,a BANRCARD NUMBER: AUTHORIZED SIGNATURE: EP A 0 Doi