2003, 06-24 Permit App: BD03-695 Plumbing Reversal ancrkan
to
\ 1. 'ey
PLUMBING PERMIT APPLICATION
PROJECT ADDRESS: b v v I , �� PERUSE: i J
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (zip)
CONTRACTOR: Li ENSE#:
D. C.ov tZ�z."ire., (�A rte°�' c.o u►RC 18 l k`l
MAILING ADDRESS: PHONE#:
609 y_5 t.1 Ss
19-(3 11 6, 1 fZR uo GRP�2.n l-te.11-es Sa, 990 IS
(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, l X $6
WASTE,VENT, REPAIR,REVERSALS li
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 FIXTURE X $6 =
- - - SUBTOTAL
1111111111111. ', ---,---2,- /
❑ CASH 0 CHECK DilIMIIIIIIR rs BE❑c_____LEPTED nrxFAn PAYMENT PLUS PROCESSINGFAXED $35.00
OF A MAJOR CREDIT CARD FEE
TOTAL PERMIT FEE e-k, /
DUE
DATE: EXPIRES: •
BANKCARD NUMBER: i5)
Q g DATHORIZED SIGNATURE: -