HomeMy WebLinkAbout2802 STATE ST; ; 77-2426; PermitPLUMBING PERMIT APPLICATION ~ 5
Applicant to complete numbered spaces only.
City of CARLSBAD, CALIFORNIA 92008 .. .,
Permit No. 7 7--...J (/ ){; Phone 729-1181
L[GAL 1 ouc•. I LOT NO.
STATE St, I T•ACT
20
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~t-ATE S/-72_9 -791/2
3 CONT"A?;'~ 1-F, MAIL ADDRESS
AltCl-tlTCCT Oflt OESIGNCft MAIL ADDRESS
4
[NGilNECJII MAIL A00ft[S5
5 ...
COMPENSATION (NS. C ARRI ER
6
7
USC OF B UILDING
RFTAJJ...
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5ALES
8 Class of work : 0 NEW 0 ADDITION _.RALTERATION
9 0 escribe work:
. .
SPECIAL CONDITIONS:
'
APPLICATION A(,CEPTEO BY ;t-ANS CHE CKE OBY APPROVEO FOR ISSUANCE BY
/-'
// DATE
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC·
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM•
MENCED.
I H EREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATIO N ANO KNOW THE SAME TO BE TRUE ANO CORRECT.
ALL PROVISIONS OF LAWS ANO O RDINANCES GOVERNING THIS
TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIO NS OF ANY OTHER STATE OR LOCAL LAW REGULATING
CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
{DATE)
51GtilATt.J•• o, OWIIILJI rT,. OIN'lllf"E,..,.U lOER-, , m •TE)
PHONIE. STATE Lrc. NO.
PHON C LICENSE NO,
PHOM[ LICENSE NO.
IIU,NCH
0 REPAIR ./
PERMIT FEES
No. Type of Fixture or Item
WATER CLOSET (TOILET) -BATHTUB
LAVATORY (WASH BASIN ) .,... SHOWER
KITCHEN SINK & OISP.
DISHWASHER
I LAUNDRY T RAY l
CLOTHES WASHER
WATER HEATER
URINAL
DRINKING FOUNTAIN
FLOOR-SINK OR DRAIN
SLOP SINK
GAS SYSTEMS: NO.OUTLETS
WATER PIPING & TREATING EQUIP.
WASTE INTERCEPTOR
VACUU M BREAKERS
LAWN SPRINKLER SYSTEM
SEWER NUMBER CLEANOUTS
CESSPOOL
SEPTIC TANK & PIT
ROOF DRAINS
ISSUANCE FEE
TOTAL FEES
;/ ij WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. -~ ,
INSPECTOR
CITY LIC. NO.
I
Fee
-
$ /,< '/)/1
CASH
..
APPLICATION FOR PERMIT TO CONNECT TO CITY SEWER SYSTEM
CITY OF CARLSBAD
ENGINEERING DEPARTMENT
729-1181 EXT. 35
FOR APPLICANT TO FILL IN
BUILDING
ADDRESS
OWNER
MAILING
ADDRESS
CONTRACTOR
CONTRACTOR'S
ADDRESS
NEW BUILDING
LEGAL DESCRIPTION
REMARKS:
t
idt
EXISTING BUILDING
LATERAL LOCATION
ST.
.,.: en
LATERAL NO. _______ INSTALLATION DATE ______ __.
SE 1483 BUILDING DEPT.
ISSUED BY -----------~------
DATE ISSUED--==-=-=--=....:....."----'=----------
VALIDATION
LATERAL CHARGE COMPUTATION
STANDARD 4" (Max. H. 30', V. 10') ________ _
OVER 30' H. ___ @.,,,._ ___ FT. _________ _
OVER10'V. @ FT. _________ _
STANDARD 6" (Max. H. 30', V. 10') _________ _
OVER 30' H, ___ @ _____ FT. _________ _
OVER 10' V. @ FT,----------
TOTAL CONSTRUCTION COST----------
SERVICE CHARGE (REPAVING ETC.) _________ _
TOTAL LATERAL CHARGE _________ _
LINE COST DATA
ASSESSMENT DIST. NQ ______________ _
FRONTAGE ____ CQST PER FT. ___ TQTAL __ _
OTHER ___________________ _
CONNECTION FEE
PUMP STATION FEES
NO. UNITS ___ CQST PER UNIT ___ TOTAL---
TOTAL CHARGES (LATERAL ETC.) _________ _