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1995, 05-05 Permit App: 95002989 Lawn Sprinkler . e .. s_e_.1 , 5 r 2 � • • PLUMBING PERMIT APPLICATION FORM N Information Worksheet JOBSTREET ADDRESS: � �� CITY/STATE/ZIP Qh�/ /-e_)A PARCEL NUMBER: .OWNER:,' /4/1 °7� 713e -°A)1 PHONE NUMBER: 7'yq' /4/V . MAILING ADDRESS: -5a/9?`e •- =f • i. (Street) (City/State) (Zip) • F � , fix ,�iNKl�'es CONTRACTOR:/��ie'a-s '�i)eR(,ee6'� P LICENSE NUMBER:�?A�',eo e5 /17/2'//e `)' PHONE NUMBER: a >1 r AKIN DDRESS: i /,eU/e u� ,5"/a,) /r e /Street / (City/State) (Zip) YYY . PLUMBING WORKSHEET/FEE SCHEDULE NUMBER X EACH OF UNITS UNIT =AMOUNT DESCRIPTION ..; , x 6.00 = TOILETS>'•.:, • }:'4:L'!.•:4:{.v f.;. :'}::}::%:tii'Y,::}.;,:i}i:??.}:S�?iL`:.:i'}}:}:j•}}i}:}a*:::::ii::.}: y . x6 T y gp} /�y�•/ry�A:.:4:%:r:}:•}:?Y:}rii:•}'r}iSji:%'r-:?:•v.:1%::%::i::j i}:??•?}i}i}:^:}iirfi;is�i>}$}`v::i}:<fji}ii:i'>};:<:S:`iiii:`?::iii: y... �v'•4'•f.�t/'•�•..:rr:::::::::::v: ...::::::::::::...:/..}}::}v ::::::L}'v:::w::::;:::.:'.i:;?.}i::::}..v::::.�..?. yL:;ua;*is•:v:?•}i:.':�'}:>k3..,�:ln':;vcivic::j:ii:,•'•)xiR:'r.:3c:rR.:w.:%�iorxk?}Y ?i'•iii•}:} x 6.00 SHOWERS ` :}}}}>}}'.}:.}}}};.,:.::::::::::::::::::::::. = vv. .�<RS..:s -:<:>%>::>:<:%::>:.,•,:ii::::;:>i::.:... 6.00 .. ,..r. : ii ,`KITCHEN'''kINKS x 6.00 ��::�. .Y . .,:.. : .''' x 6.00 yti� ir:;f-.?�%i;i::?•ifi}fi::?4::?•ii}}::4}};':4i::}yy}::v:4*}}}}}'•:'i::4'J}•:.}'.}v::::: y;V:Y'iiilii:''::•si:$'::(::•.:::-...i?i;•:;:::::::..:•:.rw:::::::::•::v.' ...::n...................... 1� �1�/lA : #}i< r?• :v:w; ;4k.:• ::: :'.;•:: ::•:...........:}:::•:: x 6.00 = GARBAGE.DISPOSAL x60 ..::.::::::::::..::::::::::: �,:4:fi;?:�.:�.';�?•}�.;?:�,;:.: ,.:�.,x??;� x 6.00 - "'UTILITY SINKS # '-4 ,,•r?.:v}v IC S x 6.00 i FATE.:..R.................>> ` 3``: is><<> : <...............:> ? FLOOR'.DRAINS x 6.00 = . . ;.. :.:?.:::.:::.:.:?.:.:::.?.::.:::>?:r'i.}::;?.::..>.::::.}......:....:.... • x 6.00 yY� v. • x6.00 > :BAR'SINKS� �r< . ..:.... .:.. .:................. •Y:Hfi:• :M: r.-,,.vv.n-¢rte}ti,l:.v,.hv-x-kf4, :.:i:: = . :... .: }. ::L:?.. 6.00 .it't i- '{1:0.0�.� �:}x.>}:a?ar}.:r.::•?: a.:fG}}}}::.ix%:::;[::at:•:'.5 ;i?:o:':l::• ii:::>1:::1:>r:::. ........ / :�_J� so-4'+c•„su vw.a. 1 • x 6.00 ((? Lw '>•''”°LAWN SPRINKLER .. .00 _ • yw x 6 t r1,• '.#� . .4 rh,:.}:.... .:... .w. }.}?:�:.rwva :::.. } ._ .. ...... • - `'6'' WATER SOFTENER' x6.00 • ��.� �x 6 2: • 1�•V 'v:x• Aft '%vitiJ.:r%4h•.W.O:M:�4n.-Y+.(%tir.::::n{-....}.:..t. :. .::... • — � - '^ DRINKING FOUNTAIN . . . x 6'00 - . . SUBTOTAL • . $' • .�: 1. PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS:TOTAL PERMIT FEE DUE =$ SIGNATURE ._-y.,,‘ • ------1-)-N- a-Lice'