2003, 07-17 Permit App BLD-03-02050 Plumbing Fixtures*Wane
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PLUMBING PERMIT APPLICATION
PROJECT
ADDRESS: l
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PERMIT
USE: yl G/L'!/1. i,
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OWNER:
PHONE aydme Contact):
MAILING ADDRESS:
(street)
(city/state)
(zip)
CONTRACTO
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LICENSE #:
MAILING ADDRESS:
eo /3„
,V6 i
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PHONE #:
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r?22,
(street)
(city/state)
(zip)
PLUMBING FIXTURES
DESCRIPTION
DETAILS
# OF UNITS
X
CO S•
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,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
$6
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,
CONDENSATE
X
$6
=
12
FOUNTAINS, DRINKING
X
$6
=
13
WATER PIPING/DRAIN-IN
WASTE, VENT,
PLUMBING REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
/
X
$6
=
14
SEWAGE EJECTOR
GRINDER, SUMP PUMP
/
X
$6
=
jc--
15
WATER USING DEVICE
ICE AND/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
X
$6
16
CROSS CONNECTION
DEVICE
VACUUM BREAKER, CHECK •
VALVE, AND R.P.B.P.D. FOR:
VATS, SUMPS, TANKS, BOILERS
X
$6
=
17
SPRINKLER SYSTEM
X
$25
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6
•
=
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
=
20
MISC PLUMBING FIXTURE
X
$6
=
-
•
SUBTOTAL
•
CASH • CHECK ❑
. • 1`
PLUS PROCESSING
FEE
$35.00
FAXED PERMITS
...,..
WILL ONLY BE ACCEPTED WITFI PAYMENT
OF A MAJOR CREDIT CARD
----
TOTAL PERMIT FEE
DUE
�,
4 7
BANNCARD NUMBER:
AUTHORIZED SIGNATURE:
*name
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MECHANICAL PERMIT APPLICATION
PROJECT
ADDRESS: /5—
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PERMIT
USE: pc,,,,,./hbi
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PHONE (time Contact
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MAILING ADDRESS:
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(street)
(city/state)
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CONTRACTOR:
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LICENSE #:
1(5 7--
99
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MAILING ADDRESS:
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PHONE :
(street) `.,
(city/state)
(zip)
DESCRIPTION OF WORK
\
# OF UNITS
/1
COST
EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
OR<100,000
/
X
$15
=
2
FUEL BURNING APPLIANCE
\>100,000
X
$19
=
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
=O%"tv,<400,000
X
$50
=
4
UNLISTED APPLIANCE (ADDITIONAL FEE)
>400,000
X
$100
=
5
USED APPLIANCE(WSEC min. AFUE rating)
=OR<490,000
X
$50
=
6
USED APPLIANCE(WSEC min. AFUE rating)
>400,000
X
$100
=
7
BOILER/REFRIGERATION
1-100M B
X
$15
=
8
BOILER/REFRIGERATION
101-500 BTU
X
$28
=
9
BOILER/REFRIGERATION
501-1,900M BTU,
X
$39
=
10
BOILER/REFRIGERATION
100 1,750M BTU\
X
$57
=
11
BOILER/REFRIGERATION
+1750M BTU
\
X
$95
=
.
12
GAS LOG, GAS INSERT, GAS FIREPLACE
-
\
.,
X
$10
=
13
RANGE
-
\
X
$10
=
14
DRYER
-
X
$10
=
15
FUEL BURNING WATER HEATER /
-
\
X
$10
=
16
MISCELLANEOUS FUEL BURNINOPPL
-
\
X
$10
=
17
GAS PIPING (ea. Outlet) /
-
\
X
$1
=
18
DUCT SYSTEMS /
-
\
X
$10
=
19
VENTILATING FANS i
X
$10
=
20
AIR HANDLER (DOES NOT include ducting)
=OR<10,000CFM
$12
=
21
AIR HANDLER (DOE,S NOT include ducting)
>10,000CFM
$19
=
22
EVAPORATIVE COOLERS
-
X
$10
=
23
TYPE I HOOD
-
X
\ $50
=
24
TYPE II HOOD
-
X
$10
=
25
HEAT PUM AIR CONDITIONER
0-3 TON
X
. $12
=
26
AIR COND IONER
3-15 TON
X
$20
=
27
AIR CON ITIONER
15-30 TON
X
$25
=
28
AIR CONDITIONER
30-50 TON
X
$35
=
29
AIR CONDITIONER
+50TON
X
60
=
30
LPG STORAGE TANK
-
X
0
' =
31
WOOD OR PELLET STOVE/INSERT
-
X
$1
=
32
WOOD STOVE - FREE STANDING
-
X
$25
=
'
SUBTOTAL
:
,.� .
P✓' .:_-
` - ^'``r
WITH PAYMENT
CARD
_VISA'
• CASH • CHECK • •
PLUS PROCESSING
FEE
$35.00
FAXED PERMITS WILL ONLY BE ACCEPTED
OF A MAJOR CREDIT
rh a r. cvnrvice. •r
TOTAL PERMIT FEE
DUE
•
•
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: