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Plumber
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I Lol No. I Block I Ward
OUTSIDE WORK
f Addiiion or Replat
Date
--
NOW SEWn WATER STORMS FEES FEES RELAY S. SEWER WATER STORMS FEES
From MaIn to Curb Seplic Taaks From Main 10 Curb
From Curb to BuDding Electric Pumps From Curb 10 Building
Repair
INSIDE WORK
NO.
m.1 USED I~~
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Catch Basins
NEW
NEW
REP. I USED
FEES
NO.
NEW
REP.
USED
FEES
L
I
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./
./
./
./
Bar and Soda Wasles
Bath Tub
Wash Buln
Garbage Diopoqlo
ItOt)
1/,0-0
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Diohwashers
Conduclors
/11-1; (Ø
Grease CaJch Basins
I
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I
L
WaJer CIONt
LaundramaJs
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SIDk
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WaJar Softanars
Sump Pump III: Ejeclors
Water HaaJan
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Sanitary Bubblers
Shower BaJhs
Urinals
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Floor Dralu
Dental Cuspidon
Laundry Tubs
Service Sinks
¡""pactiOI1l I Valuation of Ihe Work Herein Described Fee Verified, Receipled and Recorded Received Permit and Inspection Fees
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In the performance of this work the undersigned owner (or his authorized agent) of said premises and his authorized Plumber he~abY .gr~e to b'e bounden by ""d
submit to .11 statutes, city ordin.nces, and rules and regulations prescribed by the Board of Public Works for the government of Plumb.rs.
It is luther .greed bY7the undersigned th.t no other uses will b. mode of the above connections except as herein.ltew-listed.