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PRED ITE
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PLUMBING PEEMIT, TYPE: ON-S1.E SERVICES He

Penta

APPLICATION DATE PERMIT NO.

This permit is issued to the Owner/Agent 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
"Building and Plumbing Bylaw".

DESCRIPTION OF WORK

ADDRESS

ZONING

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:

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 DATE
OFFICIAL ISSUED

2735
25