HomeMy WebLinkAbout1986, 05-08 Permit App: 00011064 Plumbing FixturesPLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE OwLY THOSE PARTS OF THE FORM YOU UNDERSTAND
I Project # /�`/
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Owner's Name.__,_---
LastFirst MI
Project Address (Street
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City
State
Subdivision/ Plat Name
Assessors Parcel #
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Lot
Block
Plat #
Applicant
Address
City
I State
Zip
Phone
Business Phone
Contractor... ---Address
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City
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Zip
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Phone
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Cont
License #
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Business Phone
Describe Work 1 ,
BarSink(s):
Drinking Fountaln(s):
Floor Drain (s): %
Washing Machine(s): /
I
Dsh Wshr(s):
Garb Disp(s):
Kit Sink(s): 1
Lndry/Tray(s):
Sew Eject(s):
Urinal(s):
WtrCloset (s): 7
Lav(s):
Shower(s):
Tub(s):
Bidet(s):
Other: Type;
Waste/Grease Interceptor(s):
Sewer Y N Septic/Health No.:
Electric Water Heater(s): /
Drains -Roof:
REPAIR OR ALTERATION: Drainage, Vent, Water Piping/Treatment: Y N
Lawn Sprinkler System(s), including backflow device on any one meter:
Vacuum breakers or backflow devices In excess of line 16:1-5:
(0115 +:
I certify that the above information as submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied with whether specified herein or not. The granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state of local laws regulating construction or the performance of
construction.
SIGNATURE OF
OWNER OR AGENT
APPLICATION
0 / -- DATE 3