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I Lot Ho. I Block I Ward I Addition or Replat
OUTSIDE WORK
Date
NEW SEwn WATER STORMS 'EES FEES RElAY S. SEWER WATER STORMS FEES
F...... MaIn 10 Curb ,/ Septic Tanks From Main 10 Curb
FJom Curb 10 BuDding /' 8, t:Jð Electric Pumps From Curb 10 Building
Repair .
INSIDE WORK
NO. NEW IE,. USED "ES NO. NEW REi>. USED FEES tlO. NEW RE,. USED 'EES
- - - -
Bath Tub Garbage Dl8pooala Catcb Basbuo
-
Wash Basùs Dlabwashers Conductors
- - - - -
Wat- CI_I Laundramals Grease Catch Basbuo
-
SIDk Water Softeners Sump Pump" Ejeclors
Waler Heaten Sanitary Bubblers Bar and Soda Wasles
Show- Baths Urinala
-
Floor DraIDs Denial Cuspidon
Laundry Tubo Service Sinks
~:~-~:_._n..._-_m_---m_-_n_n__Oulaide J Valuation Of.!~ Work Herein Described Fee Verified. Receipled and Recorded Received Permit and Inspection Fees
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In the performance of this work tho undersigned owner (or his authod.ed agent) of said premises and his authorized Plumber hereby agree to be bounden by end
submit to all statutes. city ordinances, and rules and regulations prescribed by the Board of Public Works for the government of Plumbers.
~igned that no other u..s will be made of the above connections except as hereinaltor listed.
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