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HomeMy WebLinkAbout2003, 09-22 Permit App: BLD-03-02554 Plumbing Reversal5�' PLUMBING PERMIT APPLICATION PROJECT ADDRESS: R 1 5 5 fax IC a DESCRIPTION PERMIT USE: # OF SNITS OWNER: COST EQUALS PHONE (Daytime Contact): qaa q/4 3 MAILING ADDRESS: l/J f 4— spAhiw.ti 1 02, q q?1,-, J (street) (city/state (zip) CONTRACTOR: 1-4 3 Cot,) s t Ru.c-"i Q 1J URINALS• LICENSE #: 1-1 S C'o_nl * If / a 3 kr MAILING ADDRESS: 11 gl7 z lea-i(eyLaa--y •Spo PHONE #: qac- 89�� 3 Kan e_, Wa.• . q9.7 Olo (street) (city/state) (zip) PLUMBING' FIXTURES BANKCARD NUMBER: AUTHORIZED SIGNATURE: DESCRIPTION DETAILS # OF SNITS 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 22 • 5 SINKS LAVSBASINS, 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 l X $6 = 6 • Dd 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 it 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 = - • --1SUBTOTAL • a Od iG <T14- ■ CASH II CHECK Cj • -r•< PLUS PROCESSING FEE $3.55.00 FAXED PERMITS • WILL ONLY BE ACCEPTED WITH PAYMENT OP AMAJOR CREDIT CARD • • TOTAL PERMIT FEE DUE ,�� O p BANKCARD NUMBER: AUTHORIZED SIGNATURE: