2003, 10-24 Permit App BLD-03-02895 Plumbing FixturesaTY aF ,
ane
.0010Valley
PLUMBING PERMIT APPLICATION
PROJECT
ADDRESS: 1 08 fs- M. I.S3 ,Ci
PERMIT
USE:
OWNER: .\ e .cv., `, �r) `s0
PHONE (Daytime Contact): C./2 y_ 6 7s)
MAILING ADDRESS: , wct. 01 e
(street)
(city/state) 3 f Kli n r� Uj)10 (zip) 9', / Z.-
CONTRACTOR:
I-4 ,- 3 C ,O IJ 3 .; R tA-c7"i o i%
LICENSE #:
N S C'o N* - 1 a 3 K. F
MAILING ADDRESS:
I g17 E 0al1e_yIA) 0-y
PHONE #:
qa— 9� /
,_,p0Kan e._, Wa- .99.oly
(street)
(city/state) (zip)
PLUMBING FIXTURES
DESCRIPTION
DETAILS
# OF UNITS
X
COST•
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
I
X
$6
=
} tic.)
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
=
. c: r
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 J
$6
s
20
MISC PLUMBING FIXTURE
X
$6
=
SUBTOTAL
■ CASH CHECK ■ : •
— --y .
_._._._-=`''.1
PLUS PROCESSING
FEE
�.3S.OQ
FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT
OF A MAJOR CREDIT CARD
naTP. r.,,,.r,
TOTAL PERMIT FEE
DUE
y 7.O Ci
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: