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2003, 04-03 Permit App: BD-03-023 Plumbing Fixtures
Sgokane ,®..S Valley PLUMBING PERMIT APPLICATION ( J - S " / J PROJECTL' ADDRESS: (por` C WoVA' t–PERMIT p - !F_! l / USE: �� p 'I OWNER: A� 74/ U /L,✓ r/7,"PHONE (Daytime Contact): yae/ _ 723.7 MAILING AD RESS: / TOILETS WATER CLOSET, BIDETS (street) (city/state) (zip) CONTRACTOR:+ // rnr//r'hi41'& //� re,,A) LICENSE #: 2 MAILING ADDRESS: PHONE It: • i _ $6 = (street) (city/state) (zip) PLUMBING FIXTURES BANKCARD NUMBER: AUTHORIZED SIGNATURE: DESCRIPTION DETAILS # OF UNITS X con: 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 = 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 MEM ■ CASH ❑ CHECK 0 — ■ `="�'`I PLUS PROCESSING FEE $35.00 aviL FAXED PEIIMITS _ . i/_ 2. "IJ ? WILL ONLY BE ACCEPTED WITH PAYMENT OF A MAJOR CREDIT CARD TOTAL PERMIT FEE DUE 59 DD BANKCARD NUMBER: AUTHORIZED SIGNATURE: