2004, 08-30 Permit App BLD-04-07512 Plumb Reversal*Wane
.0.00Valley
PLUMBING PERMIT APPLICATION
PROJECT
ADDRESS: 0 I L
, ���/C/C
PERMIT
USE:
OWNER: S .+ � LioC..
PHONE (Daytime Contact): 9
i
MAILING ADDRESS: 7 :
--
(street)
(city/state) , c_,_}z,,
(zip)
CONTRACTOR:
D , Cove 2. \" -N.Q___
,
LICENSE #: i
d_o LA Q,C. l S l ki
0,0 t\-S
MAILING ADDRESS:
I Tg ig E, s
GROPT\
,Res
PHONE #:
Sol 9D-H_E L[ c
.
a
990 I4
(street)
(city/state)
(zip)
PLUMBING' FIXTURES
DESCRIPTION
DETAILS
# OF wars
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,
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
_
( Alw
14
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6
=
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
w.:.
Y1S_ ' m
CASH ■ CHECK • 111111=MII ■ —;
PLUS PROCESSING
FEE
$35.00
FAXED PERMITS WILL ONLY BEACCEPTEDWITHPAY1LENT
OF A MAJOR CREDIT CARD
TOTAL PERMIT FEE
DUE
BANKCARDNUMBER:
AUTHORIZED SIGNATURE: