2003, 10-08 Permit App: BLD-03-02720 Plumbing ReversalSokan e�``"`
Valley
PLUMBING PERMIT APPLICATION
m3-a92�
PROJECT , 7 OA
ADDRESS:
t
S.1
DETAILS
# n UNITS
PERMIT
USE:
OWNER: •-T
EQUALS
AMOUNT
1
PHONE (Daytime Contact):
D
MAILING AD RESS
X
$6
4S4.,.fi
(street)
2
lofty/state) (zip)
CONTRACTOR:
D, Coucg.Cj < -NQ_
0,0 „,s-1--.
X
$6
LICENSE #:
d_0 tate...* l8l K1
MAILING ADDRESS:
lgStg g. S'eR.
uo._
Gr
2t.�,a-eC
PHONE #:
507 9D—y —6- LI 8s
`3a 990
$6
(street)
(city/state) • (zip)
PLUM RINGFIXTURES
DESCRIPTION
DETAILS
# n 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
LAYS/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
WASTE, VENT,
PLUMBING REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
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
r.
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
-
(D'
$6
-
V
SUBTOTAL
w,l
Y/S4 R
MI CASH ■ CHECK •
7 ■ uI
PROCESSING
FEE
$35.00
$35.00
FAXED PERMITS
WILL ONLY BE ACCEPTED WITH PAYMENT
ME
OF AMAIORCREDrr CARD
TOTAL PERMIT FEE
DUE
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: