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2003, 11-17 Permit App: BLD-03-03085 Plumbing Reversal Ill dTYOF h ti ,.0000V .. ey PLUMBING PERMIT APPLICATION PROJECT // PERMIT ADDRESS: JOO 3--C) /Y• CA);_i b USE: OWNER: RQ,. PHONE(Daytime Contact): MAILING ADDRESS: ry f (street) (city/state) (zip) CONTRACTOR: LICENSE#: D, (..C>U C.,\N2,n cQ 0,0( d-©UR Q.Q.-irc I g I P..`l MAILING ADDRESS: PHONE#: 6-07 ` -4 _E L{ g 19'311 E, slP ._ G'Ko_e.0 Pe,�c 'L3 . 99016 (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 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 1 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 = - - ---..__,I SUBTOTAL MINIM ;w : 0 CASH 0 CHECK 0 0 ..____=.1 PLUS PROCESSING FAXED PERMITS WIIS.ONLY BE ACCEPTED WITH PAYMENT $35.00 OFA MAJOR CREDIT CARD FEE TOTAL PERMIT FEE a Lop DUE _t DATE: EXPIRES: . BANKCARD NUMBER: AUTHORIZED SIGNATURE: