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2003, Permit App: BD-03-696 Plumbing Fixtures crrt # po ,,,,,0•" Valley • PLUMBING PERMIT APPLICATION ADDRESS: l 1 \ , 1 NI, CK� 1 \ ^ PERMIT f� ,(� ADDRESS: `-'^� V�61 L\ USE: !/ /✓ — el J " J‘ OWNER: PHONE(Daytime Contact): MAILING ADDRESS: (street) (city/state) (zip) CONTRACTOR: LI ENSE#: D. C.ov,�'C.�ZA\-N4Z ( ç4: C-0.LA tC. 1 g! K1 'MAILING ADDRESS: PHONE#: 5 C (1,)-4 -ELI S,C l 18 i g' E, i ua— .e.n l�e,E-eS a_ 9901 (street) (city/state) (zip) PLUMBING FIXTURES DESCRIPTION DETAILS #of UNITS X COST EQUALS AMOUNT 1 TOILETS WATER CLOSET,BIDETS X $6 = 2 URINALS - X $6 = 3 TUBSX $6 = 4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6 = - 5 SINKS LAVS/BASINS,BAR,FLOOR, X $6 KITCHEN,LAUNDRY,UTILITY, JANITOR,PHOTO,X-RAY,FOOD, PREP/CULINARY/MEAT = 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, $6 CONDENSATE X = 12 FOUNTAINS,DRINKING X $6 = 13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION, 1 X $6 WASTE,VENT, REPAIR,REVERSALS PLUMBING REVERSAL = 14 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6 = 15 WATER USING DEVICE ICE AND/OR COFFEE MAKER, X $6 HOSE BIB,STEAMER,PROOFER, CARBONATOR,SWAMP COOLER 16 CROSS CONNECTION VACUUM BREAKER,CHECK - X $6 DEVICE VALVE,AND R.P.B.P.D.FOR: VATS,SUMPS,TANKS,BOILERS = 17 SPRINKLER SYSTEM X $25 18 INTERCEPTORS GREASE TRAP,SAND TRAP, $6 CHEMICAL HOLDING TANK X = 19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 = 20 MISC PLUMBING FIXTURE X $6 = - - - SUBTOTAL . 0 CASH 0 CHECK 0 ❑ "=° PLUS PROCESSING $35.00 FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT FEE OF A MAJOR cREDIT CARD TOTAL PERMIT FEE 4/ DUE DATE: EXPIRES: BANKCARD NUMBER: - p4IIIIIID AUTHORIZED SIGNATURE: