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BUILDING DEPARTMENT <br /> <br /> APPLICATION FOR PERMIT <br /> <br />PLUMBING, INSTALLATION <br /> <br />Fee for Permit __.~2. ................ <br /> <br /> Applicant must fill in ~rom h~re.down in Ink or Indel/ble Pencli ~ ,2 ~( ~ <br />Application is hereby made to Repair Plumbing Pipes or Fixtures according to plan~ and specificatlon8 ~nd descriptio~s as given <br />below: Inst~ll <br /> <br />~o~ .............................. ~lock ............................... ~ddifion ..................................................................... <br /> <br />Own~r~m~ and Xadres~ og Owner ................................................................................................................. <br /> ,f ......... ................................ <br />Cla~ of bu[ld~ .................................................................................... Hei~h~ tn 8~ories ........................ Oeea~e~ a~ ............................... <br /> <br /> D~crip~ of Number of F~tures <br /> <br />Water Closets <br />Bath (tub) <br />Ba~ns <br /> <br />Rain Drains <br />Sinks <br /> <br />Laundry Trays <br />Garbage Disposal <br /> <br />' ............................... Drain~, Stable <br />" ~ Draina, Garage <br />". .................................. Drainz, Floor <br />' .................................... Dishwasher <br /> <br />Drinking Fountains No .................................. Urinals <br /> <br />Shower Baths "~ ............................... Slop Sinks <br />Wash Ra~ks " ................................. Elevater Wazte~ <br /> "- .............................. Boiler Blow Of~ <br /> <br />' Refrigerator Wastes" ................................ <br />" ................................ Automatlc Washers" ~ <br /> <br />" .................................. Water Heaters " '] <br /> <br />Other Fix~;ures not specified above .......................................................................................................................................................................... <br /> <br />On back o£ sheet give diagram showln~ sizes and location of fixtures, wastes, vents, soil ;pipes, drains, Sewers, and all eleanouts. <br /> <br /> Alter } <br />I agree to Repair the plumbing eystam <br /> Install <br />of Oregon. <br /> <br />according to thls description, plans and spc¢i{icatlons and the PIumb~ag Code of the State <br /> Applicant- ~ ' <br /> <br /> <br />