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SCHEDULE E

PLUMBING PERMIT, TYPE: FYIRELINE/SPRINKLER

APPLICATION DATE PERMIT NO.

This permit is issued to the Owner named below, for the purpose of the
plumbing or related work described herein. The validity of this permit is
subject, to compliance with the plans and other documents submitted with
the permit application, and to the compliance with the "Port Coquitlam
Building and Plumbing Byiaw".

DESCRIPTION OF WORK

ADDRESS

LOT |

ZONING

OWNER

CONTRACTOR

Address

Address

City

’
‘
.

City

Postal Code

SIGNATURE OF
(WNER/AGENT

Telephone

NOTES

PERMIT FEES:

Fire Hydrant(s)
Fireline
Sprinkler Head(s)
Siamese Con.

Hose Cabinet(s)
Hose Cutlet(s)
Wet/Dry Outlet(s)
Standpipe(s)
Special Inspect.
Other

TOTAL FEES:

THE ISSUANCE OF

RESPONSIBILITY BY THE CITY FOR ERRORS OR VIOLATIONS OF CODES,

BYLAWS

BUILDING
OFFICIAL

THIS PERMIT SHALL IN

P-stal Code Telephone

NAME

TELEPHONE

Fire Hydrant(s)

Metres of Line

Head(s)

Connection(s)

Cabinet(s)

Outlet(s)

Outlet(s)

Standpipe(s)

No. of Inspec.

Specify

NO CASE BE TAKEN AS ASSUMPTION OF
STATUTES OR