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APPLICATION FOR A PLIMBING FERMIT, TYPE

APPLICATION DATE:

I/We hereby make application and provide plans under the provigions of the
pertinent Bylaws for permiasion to construct, repair or alter the
following bullding or structure and agree to comply with all the
requirements of the said Bylaws and to indemify and keep harmless the
City against all claims, liabilities, judgements, costs and expensas of
whatover kind, which may in any way accrue against the said City in
consequence of, and incidental to, the granting of the Permit, if issued.

BUILDING SITE ADDRESS:

PARTIAL LEGAL DESCRIPTION: Lot # Plan #

Address Addreas

City | City

Postal Code Telephone/Fax Postal Code Telephone/Fax

No. of Meters/Items

Metere of fireline

Fire Department Connection(s)
Fire Hydrant(s)

Sprinkler Head(s)

Hose Cabinet(s)

Hose Outlet(s)

Wet/Dry Outlet(s)

Stand Pipe(s)

Ree RARER RK EAR KH We do not plan review at the
*OFFICE USE OMLY counter. Incomplete drawings may
*Parmit No.: delay your permit application.
x. Your signature acknowledges your —
*Zoning: acceptance of this policy.

*

*Fee Paid: APPLICANT

*

*Receipt : Bit OC)
* Name
«Comments :
*

* Signature

AREA KE KKK KKH K HH KH HOw H

Telephone/Fax