HomeMy WebLinkAbout1985, 11-05 Permit App: 00008587 Plumbing Fixtures PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project# e5-87
Owner's Name — Last
First MI
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Project Address(Str t me&Numb,„ /
,/ / rJI� ( 1
City State Subdivision/Plat Name
Assessors Parcel# Lot Block Plat#
8Sa 7
Applicant Address
City State Zip Phone
Business Phone
Con It itis L� ' PC/- /—/—/ Add .G 2 i i X ,.?7CJ l/
City State Zips Phone
ze3
Contact Licen Business Phone
gp _lie.2
Describe Work
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Bar Sink(s): Drinking Fountain(s): Floor Drain(s): / Washing Machine(s):
Dsh Wshr(s): Garb Disp(s): Kit Sink(s): Lndry Tray(s): Sew Eject(s):
Urinal(s): Wtr Closet(s): '7 Lav(s): 2 Shower(s): Tub(s): "• Bidet(s):
u) Other: Type;
CC
I- Waste/Grease Interceptor(s):
LL
LL Sewer Y N Septic/Health No.:
O
ca Electric Water Heater(s): ! Drains-Root:
2
Z REPAIR OR ALTERATION: Drainage,Vent,Water Piping/Treatment: Y N
Lawn Sprinkler System(s),including backf low device on any one meter:
Vacuum breakers or backflow devices in excess of line 16:1-5: (Or)5+:
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 APPLICATION
OWNER OR AGENT t L��� ,P / DATE // /O-