HomeMy WebLinkAbout2004, 08-05 Permit App: BLD-04-07261 Plumbing ReversalSgokan e�`"'"``
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PLUMBING PERMIT APPLICATION
PROJECT /,
ADDRESS: I7 I I /y LO n.k9
DESCRIPTION
PERMIT
USE:
OWNER:
PHONE (Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (zip)
CONTRACTOR:
a CoU,QCY\zi fNe- & ttiS+-:
LICENSE #:
do LAR e,c *` l 8 I R,1
MAILING ADDRESS:
l Nig 6. 51P 9ut- G epIN 1o,a-ec
PHONE#:
507 9D.y-E LI 8L
tea_ 99316
(street) (city/state) (zip)
PLUMBING FIXTURES
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION
DETAILS
# OF wars
X
COQ.
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
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
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
145.4
• CASH • CHECK 0
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PLUS PROCESSING
FEE
$35.00
FAXED PERMITS
Will ONLY BE ACCEPTED WITH PAYMENT
OF A MAJOR CREDIT CARD
TOTAL PERMIT FEE
DUE
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: