SCHEDULE F

PLUMBING PERMIT, TYPE: PLUMBING FIXTURES

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

ZONING

CONTRACTOR

Address Address

City City

Postal Code Telephone Postal Code Telephone

SIGNATURE OF NAME
QWNER/ AGENT TELEPHONE

NOTES

PERMIT FEES:
Water Closet(s) Floor Drain(s)
Wash Basin(s) Auto Washer(s)
Bath Tub(s) Laundry Tub(s)
Shower(s) Dish Washer
Sink(s) Roof Drain(s)
Water Tank(s) Bidet
Other

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
OFFICIAL