1982, 04-08 Permit App: 00004869 Plumbing FixturesPLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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1 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. Thp granting of a permit does not presume to give authority to
violate or cancel the provisions f any o er tkte of local laws regulating construction or the performance of
construction.
SIGNATURE OF APPLICATION
OWNERORAGE .DATE y"�—