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„ <br />Fixture Type .. :;. <br />,Qty <br />Fixture Type: _ ': ; <br />Qty' <br />e: )Fixture Typ <br />::Qty <br />ture :Type: <br />Fu Qty <br />Q <br />Bathtub or combination <br />bath/shower <br />Drinking fountain or water <br />cooler (per head) <br />Wash fountain <br />Gas piping outlets <br />Bidet <br />Food -waste grinder, <br />commercial <br />Receptor, indirect <br />waste <br />Clothes washer, domestic <br />Floor drain <br />Sinks <br />Dental unit, cuspidor <br />Shower, single head trap <br />Urinals <br />Dishwasher, domestic, <br />with independent drain <br />Lavatory <br />Water Closet <br />Building sewer or trailer <br />park sewer <br />Rain water system — per <br />drain (inside building) <br />Water heater and/or <br />vent <br />Industrial waste <br />pretreatment interceptor, <br />including its tap and vent, <br />except for kitchen type <br />grease interceptors <br />Repair or alteration of water <br />piping and/or water treating <br />equipment <br />Repair or alteration <br />of drainage or vent <br />piping <br />Medical gas piping system <br />serving one to five <br />inlets/outlets for specific <br />gas <br />Additional medical gas <br />inlets/outlets — six or more <br />36 <br />PLUMBING AND GAS PIPING CONTRACTOR INFORMATION <br />Company Name: es P t1Et.Cl t 'l CPCL 1P4C- ��� <br />Mailing Address: 1 1 322 [4TId -4(C S 'Tl-E✓ 6 t elf5Tht OZ <br />cit Stale tip <br />Day Telephone: 2c*a 1L04 • tiCeto <br />Fax Number: 20(0. 1192. <br />Expiration Date: 1013/ole <br />Contact Person: t'1tliee lDtot4 cAreini <br />E -Mail Address: tiC t40#k 4 €' t'leCA ca--A <br />Contractor Registration Number: r f l81 # Oet Orn- <br />Valuation of Project (contractor's bid price): $ AO, r . 00 <br />Scope of Work (please provide detailed information): I '1gQ 't b t✓ 3Co "b t. t i- 1(o r - 'A 1 -- t--1 u S4- e� L <br />f s Ox! fl eT 1 - The 1-1t -'iC re'nC -r P^OQrtr F -0t- -i Tr+� <br />E f t s Y 1 r' e s`tcT E i-t-t C t 9 - 1 ED h► IL I I o ac'rCe l--- 6 <br />Indicate type of plumbing fixtures and/or gas piping outlets being installed and the quantity below: <br />QNppliwumsWonm- Applicaiom On LinA3.2006• Pmnil Appliuuondoc <br />Revised: 4-2006 <br />bb <br />Page 5 of 6 <br />