2003, 04-18 Permit App: BD03-095 Plumbing Fixtures''Valley
PLUMBING PERMIT APPLICATION
6063 -CD°i6
PROJECT (J
ADDRESS: 0 5 , r I n_a
c,-7
DESCRIPTION
PERMIT 7 /
USE: l/ (��yyt
,�O
X
OWNER: 5t. .� 1"
ti G "VV
EQUALS
PHONE (Daytime Contact):
1
TOILETS
`eta
MAILING ADDRESS:
/
X
$6
(street)
• lefty/state)
2
(zip)
CONTRACTOR:��I�/�- Cap
1nrt e g -x p
QQQ
l h Q
LICENSE #:
$6
=
MAILING ADDRESS:
-
3c3 at N Ltl
v4,pan
PHONE#:
Ltipt-
$6
21 2 --
(street)
(c f /state)
SHOWERS (PER TRAP)
(zip)
PLUMBINGFIXTURES
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION
DETAILS
# OF 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
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
a
20
MISC PLUMBING FIXTURE
X
$6
a
-
IIII
a
- _,
SUBTOTAL
1, F%
•
CASH • CHECK III.. •
PLUS PROCESSING
FEE
$35.00
FAXED PERMITS WILL ONLY BE ACCEPTED
OF A MAJOR CREDIT
WITH PAYMENT
CARD
TOTAL PERMIT FEE
DUES
OV
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Uhel? /OUnGC O v.�, I/ >) 7 co LIP
c
4/--7Y • t%/�
/7 /1