HomeMy WebLinkAboutPermit Plumbing 20022-1-7
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CHECKLIST
PLUMBING / MECHAN ICAL
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OFFICIAL USE ONLY
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APPLItANT INFORMATION:
.. )~\t \~,., Mo..xe', \ <851~J 2>. (Q)~Hdrr{\J2.ttJ_>> ELIC\C'YU~(r)(;,
i (Name or Fi\"Q!tPlease Print) 0 .:..... . lMa_lllp:g Address) (C~~}y, or. '~~own~
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PLUMl?ING CONTRACTOR D Yes Finn '"J Cont. OSR#
Address
D No DSelf
DYes Fim ~ 4
Address
D NoD Self OIRECrXONS"fO snE~.:l~::+). t1o-z
MErnANICAL CONTRACTOR
Type of Fixture
t'LUMBING
Number of Each
Total
Sink
Lavatory (Wash Basin)
Tub (with or without shower)
Shower? separate
Water Closet (toilet/urinal)
Dishwasher
Disposer (garbage grinder)
Wash~ng Machine
Water Heater
Floor Drain
Sewer.. '-1st 50ft.
. each additional 100 ft.
Water Service--lst 100 ft.
each additional 100 ft.
Stonn and Rain Drain--lst 100 ft.
each additional 100 ft.
Special Waste Connection
Sewage and Sump Pump (eiector)
Mobile Home Sewer and Water
Other (specify)
SUB-TOTAL (Minimum $10.00)
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I. TOTAL FEE
MEGIANI CAL
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Type of Equipment Number of Each
Mechanical Pennit Base Fee
Furnace up to 100?000 BTU/H
Furnace over 100,000 BTU/H
Clothes DFyer Vent
Bathroom Ventilation Fan & Duct
Ran~e Hood with Mechanical Exhaust
Wood Stove
Air Conditioner Only
Heat Pump
Floor Furnace
Gas Piping System 1 to ,4 Outlets . I
Per Outlet ,
Cont. OSR#
Fee On Each
$ 5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
l5.ob
10.00
15.00
10.00
15.00
10.00
5.00
5.00
10.00
(Zip Code)
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Fee on Each Total
$ 10.00
$ 6.00
7.50
3.00
3.00
4.50
6.00
6.00
6.00
6.00
.50
Other (specify)
SUB-TOTAL
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C),tc@.raance ~fith OlppHcable provisions OY Or>egoU'l TOTAL FEE
l~~w'lsed Statutes, ChI'S. 447 L~ 693 ciild aprpl'lcable (.;v~IJ':>, all~ MiUI[, CiIl.l 1It:Ji1~ WI! 0 I m: "~UiH\'j'l:J.
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S'ignaturf.:'>t"t.J;::"LIL\.J (~~J ,:~\;\/--J):';te~1 .'tu' C.)~_ Permit issued bY..LX~\ir.) L_--D:::r..J '.~
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