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2003, 07-09 Permit App: BLD-03-02029 Plumbing Fixtures • aTti of ,A ' f of .alley PLUMBING PERMIT APPLICATION PROJECT J/ , l/I M w fi USE: ADDRESS: PERMIT �//-- Rrj OWNER: eta - G -e, PHONE(Daytime Contact): 2 3 O /�70 MAILING ADDRESS: 11 !,LV� in w-r- ?r� pot,ka k,t `a2 q yaa (street) AD+ (city/stater) (zip) CCS CONTRACTOR: LICENSE#: 1-4 3 (',©1J t Rt-t-cr!D lJ N S C()N - ig- 13 K F MAILING ADDRESS: PHONE#: it m ()alleyway wr�-y R - S3969 . y pC.K.a.�t e._, w0.. .99 D (street) (city/state) (zip) PLUMBING FIXTURES DESCRIPTION DETAILS #OF wins 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, X $6 KITCHEN,LAUNDRY,UTILITY, JANITOR,PHOTO,X-RAY,FOOD, PREP/CULINARY/MEAT = 6 DISHWASHER X s $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, / X $6 ( :00 WASTE,VENT, REPAIR,REVERSALS PLUMBING REVERSAL = 14 SEWAGE EJECTOR GRINDER,SUMP PUMP j _ X $6 = 6_pO 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 0 PLUS PROCESSING FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT $35.00 OF A MAJOR CREDIT CARD FEE TOTAL PERMIT FEE ®G DUE DATE: EXPIRES: BANKCARD NUMBER: • AUTHORIZED SIGNATURE: