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2003, 05-06 Permit: BD03-229 Plumbing Fixtures • 1 _ �- 2 3 ask o ,rl, w.i,, .I ".e cVck • PLUMBING PERMIT APPLICATION PROJECT PERMIT ADDRESS: 7' 2 A..., ` 64"4-12. USE: ‘,9‘...1.,-.0.07„ )/71--1— OWNER: z."--i-a_ „4„062_5,5_cmt, PHONE(Daytime Contact):` 7 %?3 MAILING ADDRESS: 7/).Z___.4_,•-e-4--.-44/(1,4,( (street) . (city/state)S , 1, (zip) ?7Zo7 CONTRACTOR:_79 LICENSE#: 0 MAILING ADDRESS: ` PHONE#: -I- r'i S e r- 23-Z 070 r. 2/ro// 7 5;:a04---1 :7- 1..e.,--712-...,..- . 979'22j (street) (city/state) (zip) _ PLUMING'FIXTURES • DESCRIPTION RETAILS #of UNITS X COST EQUALS • AMOUNT 1 TOILETS WATER CLOSET,BIDETS X $6 = 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, 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 ic 3 10 ELEC HOT WATER TANK NOTE:IF GAS SEE MECHANICAL X $6 = �J � 11 FLOOR DRAINS • . AREA,CASE,COIL,TRENCH, $6 CONDENSATE X = l 3�� i • 11 12 FOUNTAINS,DRINKING X $6 = ' t',, • 13 WATER PIPING/DRAIN-IN INSTAL • , •LTE- •TION, X $6 r- 1 `) WASTE,VENT, REPAI-,REVERSA 6 • 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 ❑ CASH p CHECK 0 0 �( PLUS PROCESSING FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT $35.00 OF A MAJOR CREDIT CARD • FEE TOTAL PERMIT FEE C� • DUE I' DATE: EXPIRES: • • BANKCARD NUMBER: • AUTHORIZED SIGNATURE: (. ' 11/ /4-/^,r) 1: ear'ccho›- _s`0 .3 /(,