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APPLICATION DATE PERMIT NO.

This permit ia issued to the Owner/Agent named below, for the purpose of
the plumbing oc related work described herein. The validity of thie
permit is subject to compliance with the plans and other documents
submitted with the permit application, and to the compliance with the
"Budlding and Plumbiag Bylaw".

DESCRIPTION OF WORK
ADDRESS

LOT
CER,

Name

Addzreas Addreanr

City . City

Postal Code Telephone Poetal Code Telephone

SIGNATURE OF NAME,
OWNER /AGENT

NOTES

PERMIT FEES:

Fire Hydrant («) Fire Hydrant (s)
Fireline Metrea of Line
Sprinkler Bead(s) Hoad(a)

Fire Dept. Con. Connect ion(s)
Howe Cabinet (s) Cabinet (s)
Hone Outlet(s) Outlet(a)
Wet/Dry Ov’ ‘at ae) Outlet (es)
Standpipe(s) Standpipe(s)
Special Inapect. No. of Inspect.
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 CODERS, STATUIEG OR

BYLAWS

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