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I Lot No. I Block I Ward I Addilion or Replal
OUTSIDE WORK
Dale
NEW SEwn WATER STORMS FEES FEES RElAY I S. SEWER WATER STORMS filS
From MaIn 10 Curb Septic Tanks From Main 10 Curb
~m Curb to BuDding Eleclric Pumps From Curb 10 BuUding
Repair ptJí if/, Oò
I
INSIDE WORK
NO. NEW UP. USID .... NO. NEW REP. USED flES "0. NEW REP. USED flES
~ - -
Bath Tub Garbage DiI~ - Caleb Bulns
- -
Wuh Buin Dilbwuhen Conduclo..
- - -
Waler CIOl8I Laundrama.IJ Gre... Calch Bulns
-
Sink Waler Softene.. Sump Pump 8< Ejeclors
Wale. Healen Sanitary Bubb1en Bar and Soda Wasles
Shower Baths Urinals I~
1--.
Floor Dr8Ú18 Denial Cuspidon -
Laundry Tubo Serrice Sinks
lnspsdio... ¡UaliOn of Ihe Work Herein Described Fee Verified. Receipled and Recorded 1'1 .RMrfl"l'~V~!!';,~iI and Inspeclion Fees
----------------------------------_--------Oulside $..--!:..Q'Þ__D______------------------------------ ¡OJ' "¡;;.",i,.ti;:n-";'¿:1,f---_Sewer F...
. ---- - --- --- - --- - -- -------_.. ----- ----Imide --"--C;;Ÿ-T;;;;~;;;----..__.._---~_l'r,~;nc;' C';¡;:~~:7; Fees
=-~11i4~ir¡¡;=~~~;. $--------- -----..-------------....---------------------"-
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In the performance of this work tha undersignad owner (or his authorized agent) of said premises and his authorized Plumber hereby agree to be bounden by and
submit to all statutes. city ordinance.. and rules and regulation. prescribed by the Board of Public Work. for the government of Plumbers.
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