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2003, 11-17 Permit App: BLD-03-03086 Plumbing Reversal dT4 OF Mk �. soi , 0 V ley PLUMBING PERMIT APPLICATION PROJECT PERMIT ADDRESS: f 4 Al,I`1 Id1_ i be...AL OWNER: 1tYlt1" PHONE(Daytime Contact): MAILING ADDRESS: E (street) (city/state) (zip) CONTRACTOR: LICENSE#: aD, Cov,(2, 2.�-Ne_ 0.,0(N., -1---. d-©LA Q.Q- 18 l ki MAILING ADDRESS: PHONE#: 507 '3D-9 ELI g1/4C 1 1 3 lig E. `5e 2 i-a- _e�RFi\ Axes 'i a- 49014 (street) (city/state) (zip) PLUMING 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 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, X $6 WASTE,VENT, REPAIR,REVERSALS PLUMBING REVERSAL 1 = 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 1111111111111 i -7:?-71 0 CASH 0 CHECK 0 ammo 0 —.._ 'J PLUS PROCESSING FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT $35.00 OF A MAJOR CREDIT CARD FEE TOTAL PERMIT FEE • DUE DATE: EXPIRES: . BANKCARD NUMBER: AUTHORIZED SIGNATURE: