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<br />07/22/2004 13:59 <br /> <br />6125291064 <br /> <br />BARNES PLBG <br /> <br />PAGE 02 <br /> <br />Detailed des::ri.ptiuIJ of work: .f'\ \ \J "''':,:~ ;'pJ '1. ~ Q ~t., <br />'" ""'ill' \, ~ '. <br />"'III>!. I""~ 1<1.........'" "t: I(; <br />'. ,; .' .......1 :A" "". ::0 <br /> <br />, i <br />\~~ f?~, ~\'\- ~ <br />I : <br /> <br />F~"tur..: (Indicate tot,,1 numb.r of ."ch) <br /> <br />i _'Clothe. W..her <br />':~ Dishwasher <br />_ D'dnki.n.~ Foantain <br />.a.. Floo~ Dnin <br />Flam.:Qlable Wa.ste Tank <br />_ Gcesse Trap <br />\ Kitchen Sink:Di.~osal <br />L La.undry Tray <br />_ Oth<Ol~ (dQsc::iba) <br />Ifg.. water heater, indicat. whQ will b. doing tho gas piping: -Sa. j? tiJ ~ S' PI M~ . <br />Ad.dre:~:r "1.q~'~ .IL.J..A~l"~"'I,.._'\~lh....) .Av-e IJ_ J+'..A)~ Phone-'# ~ J.,.. .....r.;.;J. ~i_ ,Ill"}! ~... <br />- . ! <br />State M0ch.anica1 Bond # ~::}~..~t:t2 0 Plvase check if on file I <br /> <br />, , ....ll Fees are bued on valuation. including cost of labol' and'materials. ',I <br />The minimum fee i, $45,00 + stste ",U'char1(e, ' <br /> <br />, TOTAL JOB VALUATION: $ //J 060 <br />. . . / <br /> <br />Bathtub <br /> <br />PERMIT FEE <br /> <br />SURCHARGE <br /> <br />TOTAL DUE <br /> <br />~ L"vatory (R.!) <br /> <br />Swim Poa I I <br />I <br />_ Tub Show~r (R.I); <br />L Urinal ' <br /> <br />_ Lav:a.tQl"y <br /> <br />_RPZVdve <br /> <br />....._ R.oof Dt'aiu:=: <br />L Sew.~. Pump <br />.L S\o p Sink <br /> <br />_ Va~ Breaker <br />.a. Wt\~e!' Cloj.~t <br />_ W>ter Closet (R.~) <br />L W".r Heater ' <br /> <br />_ Shower <br />_ S!;anclpipeNlash.box <br />_SumpPu",p <br /> <br />\-Valer Mltter <br /> <br />.' --'- Vla.te:r Scftene:r <br /> <br />$ ,),:J-.<)', <pC) (1 Yo%oiTotal Vah,ation-minia!umafS45.00) <br /> <br />$ <br /> <br />/. ';- 0 <br /> <br />i <br />(.0005 x Totgl Job Valuatiotl- ~um $.50) <br /> <br />$.;y ;z $' 0 <br />, <br /> <br />, <br />(make checks payable to: City ofiElli River) <br /> <br /> <br />NA!vlE OF APPLICANT !)l : ,.:,;: .t,~,,\ A. <br />Pfecw;e type or p'.J.rH <br /> <br />SIG)I.-\.Tl."RE OF A.PPLICANT~_,,&b ~ <br /> <br />"]i. ...... /i.::r .~"; <br />" L.4J_,::".,_ <br /> <br />: iI i (' ,./ <br />1'E' ,1"2"" ........ <br />D.A. . :~~':...L'~....7-=---- <br /> <br />, <br /> <br />\6~ -.=-, <br /> <br />, <br />..L <br /> <br />-----_.__.~"_._._,_... .-.-..-- <br /> <br />. 0...._.---- <br /> <br />.'--- --._--'-'-~-'''--'-----'-----'---'~--- <br />