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SCHEDULE E

PLUMBING PERMIT, TYPE: FIRELINE/SPRINKLER

APPLICATION DATE PERMIT NO.

This permit is issued to the Owner 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
Buiiding and Plumbing Bylaw".

DESCRIPTION OF WORK

ADDRESS

LOT ZONING

OHNER CONTRACTOR

Address Address

City City

Postal Code Postal Cade Telephone

SIGNATURE OF NAME
OWNER/ AGENT TELEPHONE

NOTES

PERMIT FEES:

Fire Hydrant(s) Fire Hydrant(s)
Fireline Metres of Line
Sprinkler Head(s) Head(s)
Siamese Con. Connection(s)
Hose Cabinet(s) Cabinet(s)
Hose Outlet(s) Outlet(s)
Wet/Dry Outlet(s) Outlet(s)
Standpipe({s) Standpipe(s)
Special Inspect. No. of Inspec.
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
OFFICIAL