2003, 07-03 Permit App: BLD-03-02021 Piping OF
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PLUMBING PERMIT APPLICATION
PROJECT _ PERMIT
ADDRESS: bLI) 10 j 113-\\\... USE:
OWNER: lt\- PHONE(Daytime Contact):
MAILING ADDRESS: c9A1/1�Ai
(street) (city/state) (zip) .N,
CONTRACTOR: Li ENSE#:
a �.�Oc_,,�j'Z..\tie, Cao c co tiRte... 1 S! Ki
MAILING ADDRESS: PHONE#:
Soa.LNE ti gs
198t8' C. ,v - G p P,-pc tea- 49016
(street) (city/state) (zip)
PLUMBING FIXTURES
DESCRIPTION DETAILS #or rs X COST
wars 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
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 k $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
444-;,
❑ CASH 0 CHECK 0 ONOMMI 0 —:._. .1 PLUS PROCESSING $35.00
FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT
OF A MAJOR CREDIT CARD FEE
TOTAL PERMIT FEE
DUE
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: