4F Rasy, eats te SCHEDULE @ PLUMBING PERMIT, TYPE: ON-SITE SERVICES APPLICATION DATE PERMIT NO. This permit is issued to the Qwner 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 Bylaw". DESCRIPTION OF WORK ; ADDRESS ; LOT PLAN ZONING OWNER CONTRACTOR baat Name Name Address Address City City Postal Code Telephone Postal Code Telephone SIGNATURE OF NAME OWNER/ AGENT TELEPHONE NOTES PERMIT FEES: On-Site Services Manhole(s) Interceptor(s) Catch Basin(s) Lawn Drain(s) Water Main Metres of Pipe Sanitary Sewer Metres of Pipe Storm Sewer Metres of Pipe Fire Hydrant Fire Hydrant(s) Other Specify TOTAL FEES: sssnraeestssmssscsss THE ISSUANCE OF THIS PERMIT SHALL IN NO CASE BE TAKEN AS ASSUMPTION OF RESPONSIBILITY BY THE CITY FOR ERRORS OR VIOLATIONS OF CODES, STATUTES OR BYLAWS BUILDING GATE OFFICIAL EM PAGE