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Application l~eceived <br /> <br />Date ...... <br /> <br />Application Approved ............... <br /> <br /> BUILDING DI~PARTMENT <br /> <br /> APPLICATION FOR PEtlM~T <br /> <br /> PLUMBING INSTALLATION <br /> <br />Blanks above this line not to be £llled by applicant <br /> <br />Fee for Permit ~ .................... <br /> <br /> Applicant must fill ~ fi:om here down in Ink or Indelible Pencil <br /> f Alter ) <br />Application i$ hereby made to q[ Eepair ~Plumbing Pipg~,~or Fixtures according ~ plan~ and speclficationa and descriptions a~ given <br />beI~w; t Install ) ~ ,- ~ , <br /> <br />Lot ................................ Block .............................. Addition ......................................................... ~~ ...................................................................... <br /> <br />Owne~N~me and Address of 0wn~ _~ ........................ "r~- ....................... :- ........................................................................................ <br />Name ~d Address of Plumber .--,~~.-----~~ ~ <br />Class of buflding .................................................................................... Heigh~ fn Stories ........................ Occupied ss ................................. <br /> De~ptio~ of Number ~ F~t~es <br /> ~o .................... ~- .............. Drinking Foun~Jn~ ~o ................................. Urin~l~ <br /> <br />Water Cloaet;s <br />Ba~h (tub) <br /> <br />t~a/n Drains <br />Sinks <br /> <br />Laundry Tray's <br /> <br />Garbage Disposal <br /> <br />..................................... Shower I~a~hs <br /> <br />........... ~ ................... Wash R~eks <br /> <br />................................. Drains, Stable <br /> <br />................................... Drains, Garag~ <br />.................................. Drains, Floor <br />.................................... Dishwasher <br /> <br />Other Fixtures not specified above .................................................................................................................................................................. <br /> <br /> Remarks <br /> <br />On back of sheet give diagram showing sizes and location o~ fixtures, wastes, ven~, soil pipes, drains, sawers~ a~d all cleanouts. <br /> <br /> Alter <br />I agree to I~epair ~ th~ plumbing ~yst~m ~ceording to thi~ description, plans and specifications and the Plumbing Code of ~e State <br /> Install <br /> <br /> Appliean~ .................................................................... <br /> ...... <br /> <br />" ................................ Slop Sinks <br />' ................................ Iglevator Wastes <br />' ................................ Boiler Blow <br />" ................................ Refrigerator Wastes" ...................................... <br />" ................................ Automatic Washers" ................................... <br /> <br />" ................................ Water Heaters " ..................................... <br /> <br /> <br />