APPLICATION DATE:

SCHEDULE 8

APPLICATION FOR A PLUMBING PERMIT, TYPE:

FIRELINE/ SPRINKLER

I hereby make applicatio
Bylaw for permission to construct,
or structure and agree to comply w
Bylaw and to
claims, liabilities,

ith

judgements, costs

BUILDING SITE ADDRESS:

indemnify and keep harmless

which may in any way accrue against the
of, and incidental to, the granting of the Permit, if issued.

n under the Port Coquitlam Building and Plumbing
repair or alter the following building

all the requirements of the said
the Municipality against all
and expenses of whatever kind,
said municipality in consequence

Lot #

Plan #

PARTIAL LEGAL DESCRIPTION:

OWNER

Name

Address

City

Postal Code Telephone

Meters of fireline
Siamese Connection(s)
Fire Hydrant(s)
Sprinkler Head(s)
Hose Cabinet(s)

Hose Outlet(s)
Wet/Dry Outlet(s)
Stand Pipe(s)

A AK RR RR He RK eK we Re Re we HR

CONTRACTOR

Name

Address

City

Postal Code Telephone

No. of Meters/Items

Every owner shall give at least 48

2568
17

*OFFICE USE ONLY w hours notice to a Building
* *# Inspector prior to the start ‘of
*Permit No.: sl work on the building site.

bad k

*Zoning: * APPLICANT |

t t

*Processing Fee Paid: *

* * Name

kReceipt No.: *

* *

*Comments: * Signature

k te

* te ITEM | PAGE

a Telephone