Permit: BD-03-237 Plumbing ReversalStielan' ems`"`
Valley
PLUMBING PERMIT APPLICATION
D om -2 37
PROJECT
ADDRESS: 6 I
�j.,
N Le �L,(,S I n
DETAILS
# OF UNITS
PERMIT
USE:
OWNER: O
! SIS['
AMOUNT
1
PHONE (Daytime Contact):
MAILING ADDRESS:
X
$6
(street)
(city/state) (zip)
CONTRACTOR: ,,��``__
X
LIICjENSE#: p
-`}-.
MAILING ADDRESS:
19.818' 6.
SpQj�-
TUBS
GRec4,� a-ec
PHONE #:
507 9D-4 —ELI gs
is 99016
$6
(Street)
(city/state) (zip)
PLUMBING FIXTURES
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
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 ALTERATION
SE
WASTE, VENT,
PLUMBING REVERSAL
REPAIR, REVERSALS
=
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
$8
=
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
=
20
MISC PLUMBING FIXTURE
X
$6
=
-- �SUBTOTAL
11IS s`---
n a
III CASH 15 CHECK II
_VISA
1.110111-- ■ ',- ;
PLUS PROCESSING
FEE
$35.00
FAXED PERMITS
r„,t
Will ONLY BE ACCEPTED WITH PAYMENT
OF A MAJOR CREDIT CARD
...T
TOTAL PERMIT FEE
DUE
1( 0D
1
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: