2003, 04-21 Permit App: 03002586 Sewer5,;oOVa11ey
PLUMBING PERMIT APPLICATION 6i)a 3 J 7
3ROJECT
DESOR/PT/ON
DETAILS
PERMIT
I X
I COST
WORESS:USE:
- AMOUNT
1
ITOILETS
IWATER CLOSET, BIDETS
F_--
W'ER 1,
I G^
)
PHONE (Daytime Colrtact): 6 _
2
AAILING ADDRESS:
i
t o
$6
i
3
street
cii /state
zi
:ONTRACTOR:
1
LICENSE #:
PER TRAP
BATH, STALL, ONSITE BUILT
S
Dlr
C
�.S
1
5
MRING ADDRESS:
BAR, FLOOR
PHONE #:
��6
�9Gy
118/7 E
Ua�ley�"f
KITCHEN, LAUNDRY, UTILITY,
ILAVS/SASINS,
JANITOR, PHOTO, X-RAY, FOOD,
street
ci /state(zip)
PLUMRTNOFIXTURES
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESOR/PT/ON
DETAILS
.r #F #N?f
I X
I COST
EQUALS
- AMOUNT
1
ITOILETS
IWATER CLOSET, BIDETS
X
$6
2
URINALS
I
X
$6
3
TUBS
I
X
$61
1
4SHOWERS
PER TRAP
BATH, STALL, ONSITE BUILT
I X
1 $61
1
5
SINKS
BAR, FLOOR
X
jB
KITCHEN, LAUNDRY, UTILITY,
ILAVS/SASINS,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CUUNARY/MEAT
6
DISHWASHER
X
$6
7
CLOTHES WASHER
X
$6
8
GARBAGE DISPOSAL
X
$6
9
WATER SOFTENER
X
$6
10
ELEC HOT WATERTANK
NOTE: IF GAS SEE MECHANICAL
X
$6
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
$6
CONDENSATE
X
72
FOUNTAINS, DRINKING
7(
$6
10
WATER PIPING/DRAIN-IN
INSTALLATION, ALTERATION,
X
$6
WASTE, VENT,
REPAIR, REVERSALS
PLUMBING REVERSAL
1{
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
T(
79
MEDICAL GAS per outlet
NITROUS,OXYGEN
X
$6
20
MISC PLUMBING FIXTURE
X
$6
-
SUBTOTAL
❑ CASH ❑ CHECK ❑ !v ❑
PLUS PROCESSING
PAXpp PWAiS m140MYae AC(YPTPDF2HPATMCM
$35.00
OP ANAJOICmna
FEE
TOTAL PERMIT FEE
K
DUE
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: