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Lot No. Block Ward Addition or Replat
OUTSIDE WORK
Date
NEW SEWEll WATER STORMS '..S ".. .ElAY S. S.W.. WAT.' STORMS ,..s
From MaID to Curb Septic Tanks From Main 10 Curb
!\'om Curb to B\II1dlng Electric Pumps From Curb 10 Building
Repair
INSIDE WORK
NO. NEW "P. USED FEes NO. N.W "P. use. FEeS NO. NEW 'EP. USE. 'EES
Bath Tub aMbag" Diopoeals / I. ,'T) Calch Basins
I-
Wash Basbs Dlshwalhen I I'~ Conductors
- ~ - -
Wat.. CloHl Laundramals Ore.... Cuch Basins
SIaJr / !.,-d Wilier Softeners Sump Pump &: Ejectors
Water Heaten 3ani111Zy Bubblers Bar and Soda Walles
8ho.... Baths UrùuiJa
Floor Drllhls Denial Cuspidors
Laundry Tubs Service Sinks
Inspec:lions Valuation of the Work Herein Described Fee Verified, Receipted and Recorded Received Permit and Inspection Fees
- ------------ ------- Ou!sicle $----d:.£()_:--~-----------------_...------- =~~::;I:~:::u::r F:'7
- -... ---- --..--------_-__--InIlde
$.-....-------------...-...----------..........----.--. S r-cJ
------------ -----------'--""--'--ëïtŸ-T;;;;~;;;---"'-----"-------- ----------..:--------- Total
---------F1Dal OK $----------------.-------.-------------- Dale c:1.. . .s:-. 7 (Ó
In the performance of this work the undersigned owner (or his authorbad 8gent) of said premise. and his authorized Plumber hereby agree to be bounden by end
submit to .11 slalutes, city ordinances, and rules and regulations prescribed by the Board of Public Works for the government of Plumbers.
It Is fulher agreed by the undersigned that no other use. will be made of tho above connection. except .. hereinafter lisled.
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---~~-_. Plumbl.. I......., ß
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