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I Lot No. I Block I Ward I Addition or Replat
OUTSIDE WORK
Permit N<? 9075
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Date
NI'It SEwn WA"R STORMS FEES fEES RElAY S. SEWER WATER STORMS fEES
From MaID to Curb Septic Tanks From Main to Curb
f}om Curb to Building Elecirlc Pumps From Curb to Building
Repair
INSIDE WORK
NO. NEW RIP. USED FIlS NO. NEW REP. ~ FEES 1<0. NEW IEP. USED FEES
Bath Tub - aorbage DllpooaIs Catch BulN
Wuh BulD I ~rO Dishwuhen Conductors
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Wuer Clooet I ¡ø Laundr8JDll.bi areue Catch BulN
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SIDII: Water Softeners Sump Pump Ik Ejectors
Water Heue.. Sanilery Bubblers Bor and Soda Wasles
Shower Bath8 J ¡o-CI UrlDais
Floor Dzalna Denial Cuspidors
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Laundry Tubs I ,,-d Service Sinks
Inspections Valuation of Ihe Work Herein Described Fee Verified. Recelpled and Reco~éíed Recaived Permit and Inspection Fees
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In the performlnce of this work thl undersigned owner (or his euthori.ed Igent) of ..id premises Ind his luthorized Plumber hereby Igree to bl bounden by end
submit to III stltules, city ordinlnces, Ind rules and regulltions prescribed by the Board of Public Works for the government of Plumbers.
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It Is father Igreed by the undersigned thlt no other uses will be mode of the Ibove connections exCl,
1-eineftlr listed.