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APPLICATION DATE PERMIT NO.

This permit is issued to the Owner/Agent named below, for the purpose of
the plumbing or related work deacribed herein. The validity of this
permit is asaubject 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

LOT

Name

Address Oe Address

Clty City

Postal Code =i (“ti(tststé«CS DL _ Postal Code
SIGNATURE OF NAME.
-OWNER/AGENT Ea

TELEPHONE

PERMIT FEES: - a
‘Fire Hydrant(s)  — _ tS CFire Hydrant (se):

_ Fireline oe | Metres of Line
‘Sprinkler Head(s) cee _ Bead(s)
“Fire Dept. Con. . 9 _.. rs Connection(s)
Hose Cabinet(s) -° Lu (Cab inet (s) ©
‘Hose Outlet(s) 2 _. Outlet(s)..
Wet/Dry outlet (s) rans  Outlet(s)—
Standpipe(s) — LL  Standpipe(s)
No. Of. Inspect.
Specify — |

we ‘testlance OF THIS PERMIT SHALL IN NO CASE BE TAKEN AS ASSUMPTION OF.
[RESPONSIBILITY BY THE CITY FOR ERRORS OR VIOLATIONS OF CODES, “STATUTES OR