2003, 06-09 Permit: BD-03-238 Plumbing Reversal*Wane�`
Walley
PLUMBING PERMIT APPLICATION
13Do3-23
PROJECT N
ADDRESS:Lj t-, J c:t t-cct
DESCRIPTION
PERMIT
USE:
^
OWNER: fel et -?_A s 1 Le
X
PHONE (Daytime Contact):
MAILING ADDRESS:
AMOUNT
(street)
city/state) (zip)
CONTRACTOR:
4
I ENSEo#:
taRz.c.. 1sit, R`(
ID,CovtZch2.i -N� C,oR
MAILING ADDRESS:
tA.
19-'3 g r` , sSp (“,rg1-QR_
GK fi' P {\ /Tt',P
PHONE #:
507 9D.,y-EH 8s
990
(street)
(city/state)f�a
P 6
PLUMBING FIXTURES
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zoe aczi3-
-a-o3
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,
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
INSTALLATION Al TFRATION
$6
WASTE, VENT,
PLUMBING REVERSAL
REPAIR, REVERSALS
A
=
/
(p 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
`
/_ t%U
w
i� iL 1' i.,
■ CASH IN CHECK ■
• •
PLUS PROCESSING
FEE
$35.00
FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT
OF A MAJOR CREDIT CARD
TOTAL PERMIT FEE
DUE
l
W. o6
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zoe aczi3-
-a-o3