2003, Permit: BD03-536 Plumbing Reversal art of .oh;00 . .
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• PLUMBING PERMIT APPLICATION ._. 5-3c,
PROJECT ` PERMIT
ADDRESS: M (�"1 `S ��— USE:
OWNER: n 4c,9 PHONE(Daytime Contact):�
MAILING ADDRESS: SKvvy
(street) (city/state) (zip)
CONTRACTOR: LICENSE#:
MAILING ADDRESS: PHONE#:
19-g t Si C. Sp — .e•r e,I S t3 a_ 94014
(street) (city/state) (zip)
PLUMING'FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS • AMOUNT
1 TOILETS • WATER CLOSET,BIDETS X $6 = .
2 URINALS V • X $6 =
3 TUBS X $6 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT r X $6 = •
5 SINKS LAVS/BASINS,BAR,FLOOR, X $6
KITCHEN,LAUNDRY,UTILITY,
JANITOR,PHOTO,X-RAY,FOOD, _
PREP/CULINARY/MEAT
6 DISHWASHER X V $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 = Lo
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
;w4: ;
0 CASH 0 CHECK p MEI= 0 - -'=- 1 PLUS PROCESSING
FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT $35.00
OFA MAJOR CREDIT CARD FEE
. TOTAL PERMIT FEE 'I
• DUE `t (-03
DATE: EXPIRES: .
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: