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2003, 04-16 Permit: BD-03-090 Plumbing ReversalPLUMBING PERMIT APPLICATION PROJECT ADDRESS: 6-9/2- etPERMIT DETAILS USE: OWNER: e..09p/S �/Q OIC 0 EQUALS PHONE (Daytime Contact): MAILING ADDRESS: G'(J�Z r p/.., S g4- ioi' ®ale; -..,y _ (street) ,fe(ht[state) (zip) RACTOORJ/:// /J �� l/ 7-0E-4--Vit-0E-4--Vitez LICENSE it: ) 2GF G 00g eT/4- MAILING ADDRESS: / -1 )47767 ZI- S PHONE #: 593207(9 C - 2/(52O1/4-7 �r,st„... 792.2] = (street) j-^ (city/state) (z'p) BANKCARD NVMBER: AUTHORIZED SIGNATURE: DESCRIPTION DETAILS ♦o# tarn X COSY EQUALS - AMOUNT 1 TOILETS WATER CLOSET, BIDETS X $6 2 URINALS X '56 = 3 TUBS X 56 = 4 SHOWERS (PER TRAP) BATH, STALL, ONSITE BUILT X 55 5 SINKS LAVSBASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY, FOOD, PREP/CULINARY/MEAT X 56 6 DISHWASHER X 56 = 7 CLOTHES WASHER X 56 = 8 GARBAGE DISPOSAL , X $6 = 9 WATER SOFTENER x 56 = 10 ELEC HOT WATER TANK NOTE: IF GAS SEE MECHANICAL X 56 = 11 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE X $6 = 12 FOUNTAINS, DRINKING x $6 = 13 WATER PIPING/DRAIN-IN WASTE, VENT; PLUMBING REVERSAL INSTAL TE TION, REPAI ,REVERS ��/��/ X 56 = Lib l0 14 SEWAGE EJECTOR GRINDER, SUMP PUMP X. $8 4 15 WATER USING DEVICE ICE AND/OR COFFEE MAKER, HOSE BIB, STEAMER, PROOFER, CARBONATOR, SWAMP COOLER X 56 c 16 CROSS CONNECTION DEVICE VACUUM BREAKER, CHECK VALVE, AND R.P.B.P.D. FOR: VATS, SUMPS, TANKS, BOILERS X $8 a 17 SPRINKLER SYSTEM . x 525 16 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK x 56 _ 19 MEDICAL GAS per outlet NITROUS, OXYGEN X 56 20 MISC PLUMBING FIXTURE X $B - • SUBTOTAL (9 ,r,.. liter riV:F troy. • CASH • CHECK D - - ' PLUS PROCESSING FEE $35.00 PASPO PQRMis tap. ONLYHB ACCEPTED WITHPAYb@cr OP A IVOR CREDIT CARD -.— ___- ... TOTAL PERMIT FEE DUE /r I pn w BANKCARD NVMBER: AUTHORIZED SIGNATURE: