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2003, 08-04 Permit App: BLD-03-02131 Plumbing Reversal, Fixtures SVOVial .ne 4000 Valley • PLUMBING PERMIT APPLICATION PROJECT � 869 6.... ..y/ PERMIT ADDRESS: 1��- USE: OWNER: PHONE(Daytime Contact): MAILING ADDRESS: (J _. (street) (city/tate) (zip) CONTRACTOR: LICENSE#: D, C.Ov.Q,03.\z.\�4z., CSA(‘.< -1-. do.Lik tc_* 18 I k`2 MAILING ADDRESS: PHONE#: roc/ Ciay_511 Ss 19-(3 11 e 5e U ��e.c‘�el t3 49016 (street) (city/state) (zip) PLUMSINO FIXTURES DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT 1 TOILETS WATER CLOSET,BIDETS I X $6 = • 2 URINALS - X $6 = 3 TUBS r X $6 = 4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6 = • 5 SINKS LAVSBASINS,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 w 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 0 CASH 0 CHECK °TS BE 11111131111110 0 .-_. WITHPAn M PLUS PROCESSING FAXED Pr $35.00 OF A MAJOR CREDIT CARD FEE TOTAL PERMIT FEE DUE DATE: EXPIRES: . BANKCARD NUMBER: AUTHORIZED SIGNATURE: