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2003, 05-14 Permit: BD03-079 Plumbing Reversalsgokan e�``""' ,,,�,I•'�'alley PLUMBING PERMIT APPLICATION B003-07 PROJECT y / ADDRESS: I�QA Loco -j oco z7 DESCRIPTION PERMIT USE: # OF wins OWNER: d) YL_ rkJIC_14-?. Ee COST PHONE (Daytime Contact): Lf ue (43,5--- 4 -- MAILING MAILING ADDRESS: rl;0 BOX -r7 ;� kN-+ �i A -y LO A- ??.t. 21 (street) (city/state) (zip) CONT FiBCCTD 2 LICENSE #: MAILINGvv`P.//DDRESS: X $6 PHONE #: 3 TUBS (street) (city/state) (zip) PLUMBING FIXTURES BANKCARD NUMBER: AUTHORIZED SIGNATURE: DESCRIPTION DETAILS # OF wins X COST EQUALS ' AMOUNT 2( 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 = c j IC 13 WATER PIPING/DRAIN-IN WASTE, VENT, REVERSAL INSTALLATION, ALTERATION,/ REPAIR, REVERSALS/v`^/PLUMBING X $6 = r i2e 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 = 0 - SUBTOTAL ' � a CASH II CHECK ■ . ■ - 1 " PLUS PROCESSING FEE $35.00 FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT OF A MAJOR CREDIT CARD TOTAL PERMIT FEE DUE fir- ' BANKCARD NUMBER: AUTHORIZED SIGNATURE: