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I Lot No. b I Ward I Addilion or Replal
OUTSIDE WORK
N-
of
Plumber
Daie
NIIW SIW" WATER S'ORMS 'IES FEES .ELAY S. SEWER WATER S'ORMS FEES
From MaIn 10 Curb Seplic Tanks From Main 10 Curb
From Curb 10 BuIldln¡¡ Electric Pumps From Curb 10 Building V I r oz::)
Repair ~
INSIDE WORK
NO. NEW UP. USED FEES NO. NEW .EP, USE. FEES NO. NEW RIP. USED 'EES
- - - -
Ba!b Tub Gorbage DIs~ Ca!ch Basins
- - - -
Wub Basin Dlsbwashers Conduclors
- - - - -
Waier CIOI8I Laundrama.b Grease Catch Basins
-
Sink Water Softeners Sump Pump II: Ejeclors
Waier Heaiers Sanilary Bubblers Bor and Soda Wasles
Shower BaIhs Urinals -~
- -
noor Dr81D8 Denial Cuspidors
-
Laundry Tube Service Sinks
Iuspocliollll :~I~;;~:~:i:_::::_:: Fee Verified. Receipled and Recorded Received Perml! and Inspecllon Fees
---.------.------------.--------..-.-____---Oullide ---...---------------.----88wer Fees
------------------......---------.--------.---.------In.ide --------/..~.Æ'ð----plbg. Faa.
----.----------------------------------.-------- $----------------------......-----------..---------------------...----...-- D~~:-#~?
------.---------------FiDaI OK $--------.--------------.-----------------..-.----------.------------ -----------------------'-'C;Í:;-T;';;;~;ë;--------------------------
In the peñormance of this work the undersigned owner (or his euthorired agent) of said premises and his authorized Plumber hereby agree to be bounden by and
submit to all statutes, city ordinances, and rules and regulations prescribed by the Board of Public Works for the government of Plumbers.
It Is futher agreed by the undersigned that no other uses will be made of the above connections except as hereinafter listed.
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Z::;;¡-(_,,"r:~ ;7 Plumbo, 7------
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