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2003, 04-21 Permit App: BD03-114 Piping CIT t,111L€ . '��iJt .000Valley CsOb.--s-- ti4 • PLUMBING PERMIT APPLICATION PROJECT �, PERMIT I�n�� 6 ADDRESS: -4- Q y --A.,01.-1-1,--_ USE: OWNER: ` -bi\eS PHONE(Daytime Contact): MAILING ADDRESS: 10-10.-- L V9-r-A- r+ec,. (street) J city/state) (zip) CONTRACTOR: LI ENSE#: D. c)u -Nfr oLARte_Ak lSl K.1 MAILING ADDRESS: PHONE#: 5 6-Qsf-- - P (Lt. t 507 day-ELI g, 1 c 8 IS' E. 4( Ptctuita._ G" '_e-r Ae,p-e c 1,3a_ 49016 Lj (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, 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 $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 = - . - -- I SUBTOTAL 111111111111111 _ ,I:,-- (O. 0 CASH 0 CHECK 0 0 .--. =--' PLUS PROCESSING FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT $35.00 OFA MAJOR CREDIT CARD FEE TOTAL PERMIT FEE y DUE DATE: EXPIRES: . BANKCARD NUMBER: AUTHORIZED SIGNATURE: 1//7 lv 14 , /vim 1/%2 /--0 3 2,<!/:/ c // ' ( l/