NO PERMIT NUMBER (7)No. Street
APPLICATION FOR,LLUMBINC PERMIT
Tq
® rT,;�'I C'Jj��LLi ary No.
Date O yrytS 1 4 1968 Permit
Application is hereby rt�I+ty
and/or fixture listed onn 911 de�.}[[de h r
in accordance with the provisions of the Plumbing
laws applicable thereto.
Use of Premises //?
Owner/.') C', ,Q /} Ss C-4 7,1
ByCTL�lE<S ��y SBC.
Contractor, Agent
Phone
State Licensees
Lot No.
Fee $7,z
permit to install plumbing pipes
;/Stall said prices ankr fixtures
City of Cuoertin d allZ Aer •
Address �vn -rte frN o
IF
Address 149195; left r a.orcl A --
rl OF '"Mmbing Inspector .00,
FIXTURES NUMBER
MAIN DRAIN
Units Fees
Units Fees
Water Heater
Size
Water Closet
Material
Bath Tub
Shower
Lavatories
"t e k
Dish Washer
M
Waste Dis osal
Wash Tra
AINAGE
Washin Machine
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand TrapTOTAL
FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
Relief Valve
11 Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee