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| DIVISION OF BUILDING INSPECTIONS |
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| PLUMBING Permit |
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| Contractor's License
Number: |
Permit Number: |
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| Location: |
Building
Permit Number: |
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| Owner: |
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| Kind of Building: |
Used As: |
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| Approximate
Completion Date: |
Estimated
Cost: |
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| New: |
Alteration: |
Repair: |
Addition: |
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| Item |
Number |
Description /
Remarks |
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| Stacks |
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| Sinks |
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| Baths |
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| Water Closet |
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| Lavatory |
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| Tank & Heater |
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| Laundry Tray |
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| Water Distribution
Systems |
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| Floor Drains |
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| Sewage Ejector |
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| Fountain (Drinking) |
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| Sump |
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| Showers |
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| Urinal |
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| Catch Basin |
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| Dishwashing Machine |
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| Humidifier |
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| Garbage Grinder |
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| Washing Machine |
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| Special Wastes |
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| Rainwater Leaders |
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| Miscellaneous
Fixtures |
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Total Fee: $ |
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| Note: |
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| Contractor's Name
& Address: |
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| City: |
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State: |
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Zip: |
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| Ready
for Inspection on ____/___/____ |
or
will contact the Inspection Department no later than 24 hours prior to
requested inspection. |
| Applicant
certifies that all information given is correct and that all pertinent
Building Codes will be complied with in performing the work for |
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this permit is issued. |
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| Signature of Contractor |
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Code Official |
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| (or authorized
representative making application) |
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234-3601 |
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