2003, 11-14 Permit App BLD-03-03073 Plumbing FixturesPLUMBING PERMIT APPLICATION
PROJECT
ADDRESS: I (" L-3J IUr`
OWNER:
MAILING ADDRESS:
PERMIT
USE:
PHONE (Daytime Contact):
c�o vt� P.
(street)
CONTRACTOR:
1-4 4- 3 C .c) k t c-1 i /\I
MAILING ADDRESS:
I1 gl7 E a-
l
(eyt,
(street)
PHONE #:
G?v /c.9I%
(city/state) ' (zip)
LICENSE #:
N s C'() N*
(city/state)
(zip)
PLUM8/NG
DESCRIPTION
DETAILS
# OF UNITS
x
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
)
X
$6
=
��
2
URINALS
X
$6
=
.D�
3
TUBS
X
$6
= =
4
SHOWERS (PER TRAP)
BATH, STALL, ON -SITE BUILT
X
$6
=
5
SINKS41::
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
j
X
$6
. eiD
f? t
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
=
t ,.(;
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
=
II CASH
amorit
VISA
t14 .-a , { +
SUBTOTAL
�, U
•
CHECK Et .
•
.__.._�_--
PLUS PROCESSING
FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT
OF A MAJOR CREDIT CARD
FEE
�1
,$3rj OQ
DATE: FPm VC. X
TOTAL PERMIT FEE
DUE
I '
-'
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: