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2011, 04-27 Permit App: 11001081 Tear off, ReroofSiaane %Valley PLUMBING PERMIT APPLICATION 30 o-3- nu - PROJECT PERMIT ADDRESS: u - ADDRESS: q -7 I 0 C. Nd USE: OWNER: PHONE (Daytime Contact): MAILING ADDRESS: QQn. 97/ 0 E NOP_1}- (street) city/state)'fp (zip) CONTRACTOR: TOILETS LICENSE #: MAILING ADDRESS: 'des*u `"C\u N , 1 tcig t. se 9o044.1 Yaep ,.._ GIVE .\h,a-es PHONE #: s°7 9D -4_g -1 ZS - slcp L`a 99a16 (street) (city/state) (zip) PLUMBING FIXTURES BANKCARD NUMBER: AUTHORIZED SIGNATURE: DESCRIPTION DETAILS # OF UNITS X QQn. 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 / (9 A9° NNW IRS 1115.4 CASH ■ CHECK ■ S .__ .: PLUS PROCESSING FEE $35.00 FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT OFA MAJOR CREDIT CARD TOTAL PERMIT FEE DUE I c'CO BANKCARD NUMBER: AUTHORIZED SIGNATURE: