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R# <br />ER# <br />pplicant to complete numbered spaces only. No. 3745 <br />CITY OF LITTLE CANADA <br />484 -2177 FAX 484 -4538 <br />PLUMBING PERMIT APPLICATION <br />0 <br />j0 ADOR S <br />2yji S VANOC. 616 <br />\. LOT NO, I 9LIL <br />LEGAL <br />DESCR. <br />PROPERTY IDENTIFICATION NO, <br />TRACT <br />0 SEES ATTACHED SHEET <br />I.WLADORESS <br />2 ONTIEFI <br />/N DP PHONE <br />1 0N fWD N ij`J 2 %19 V NDEIW& 5r Lc 55i "7 1tPHS b 344" <br />PHONE UCENSE Na <br />CONTRACTOR HMI-ADDRESS <br />Class of work: <br />VNEW D ADDITION <br />❑ ALTERATION 0 REPAIR <br />Deschbewo6,:7n5yr i e GU 4-15A, <br />Details or Remarks: <br />It shall be the duty of the plumbing contractor to notify the <br />proper Administrative Authority and the Owner, or his authorized agent <br />orally, by telephone, or in writing, not less than, eight working hours <br />between the hours of 8 a.m. and 4 p.m. before the work is to be inspect- <br />ed or tested <br />" 7"'WCALt48421/TFORINS ECTION. • <br />This' permit becomes null and void if work or cons tructon <br />authorized is not commenced within 120 days, or if construction or work "y <br />is suspended or abandoned for a period of 120 days at any time after <br />work is commenced <br />I hereby certify that I have read and examined this appltoation : I, <br />and know the'sarne to be true and correct All provision, of laws and I <br />ordinances governing this typeof work will be complied'with whether ''y <br />`specified herein or riot: The granting of a permit does not presume to 4; <br />give authority to violate or canoe! the provisions of any other state or <br />local law regulating construction or the performance ofconstruction. <br />PENALTY FOR VIOLATION OF ANY OF THE PROVISIONS .y <br />OF BUILDING CODE OR ORDINANCE: FINE FROM FIVE DOLLARS <br />TO ONE HUNDRED DOLLARS OR IMPRISONMENT FOR FROM <br />FIVE TO NINETY DAYS. <br />Type of Fixture a Item <br />WATER CLOSET ( TOILET) <br />Fee <br />BATHTUB <br />WHIRLPOOL <br />LAVATORY ( WASH BASIN ) <br />SHOWER <br />KITCHEN SINK & DISP • • <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN` <br />FLOOR SINK OR DRAIN <br />GAS SYSTEMS:. NO. OUTLETS <br />WATER PIPING & TREATING EQUIP. <br />Signature of Contractor or Authorized Agent or Owner <br />(Date) <br />WASTE INTERCEPTOR <br />CITY OF L 'TILE CANADA <br />WHEN PROPI <br />1�� <br />SY C-?‘ i5/1 <br />VACUUM BREAKERS': -- <br />LAWN SPRINKLER SYSTEM- ;' <br />SEWER UNE SAN.: <br />WATER METERS.::, <br />OUTSIDE FAUCET r. <br />INSIDE PLUMBING <br />INSIDE WATER <br />OUTSIDE WATER'.'._, <br />OUTSIDE SEWER <br />WELL �r <br />OTHER • <br />...r <br />STATE SURCHARGE......'. • "' . <br />OTHER. . ..._. ^..< r (AY- O, OA ` <br />PENALTY <br />Page 11 <br />• TOTAL FEE <br />IS IS YOUR PERMIT -` <br />ATION CK:. M.O. CASH <br />Receipt No. <br />