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HomeMy WebLinkAbout2004, 04-26 Permit App: BLD-04-04196 Plumbing Reversal .0,00Valley • PLUMBING PERMIT APPLICATION PROJECT . Co NA PERMIT ADDRESS: ,l SS1 \ NVUSE: OWNER: M���.\ PHONE(Daytime Contact): MAILING ADDR S: ,`m,:, (7,` \ v,e (street) (city/state) (zip) CONTRACTOR: LICENSE#: MAILING ADDRESS: PHONE#: SO7 4ay _E LI g'g 19-(3t8' E, 5P - ,e4., Pp c t3a, 440 1 z (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 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 = 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 WASTE,VENT, REPAIR,REVERSALS I . 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 FIXTUREX $6 = - - - - SUBTOTAL VISA : i4£a-` : 0 CASH 0 CHECK 0 0 -_.-.. 7':• PLUS PROCESSING FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT $35.00 OFA MAJOR CREDIT CARD FEE TOTAL PERMIT FEE DUE DATE: EXPIRES: BANKCARD NUMBER: • AUTHORIZED SIGNATURE: