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Starting Date: ' Completion Date: _ <br />Number of Stories: Number of Dwelling Units: <br />Water Closet �� Water Heating Device- Gas — Otherz <br />Lavatory <br />- -Bath Tub <br />Shower ,f <br />Sink <br />Disposal <br />Dishwasher <br />_ Laundry Tray <br />Standpipe or washer box <br />Floor Drain <br />Water Closet rough -in. <br />Lavatory rough -in <br />Other rough -in <br />Remarks: <br />Water Softener <br />Sump Pump <br />Sewage Pump <br />Catch Basin <br />Yard. Sprinkler <br />Urinal <br />Slop Sink <br />Drinking Fountain <br />Swimming Pool Piping <br />Rainwater Leader <br />Other <br />I HEREBY APPLY FOR A -PLUMBING PERMIT, AND I ACKNOWLEDGE THAT THE <br />INFORMATION ABOVE IS COMPLETE AND ACCURATE; THAT I UNDERSTAND THIS <br />IS NOT A PERMIT AND WORD IS NOT TO START WITHOUT A PERMIT. <br />I UNDERSTAND AND HEREBY AGREE THAT THE WORK FOR WHICH THE PERMIT <br />ISSUED SH_4LL BE PERFORMED ACCORDING TO; (1) THE CONDITIONS OF THE <br />PERMIT; (2) THE APPROVED PLANS AND SPECIFICATIONS; (3) THE APPLICABLE <br />CITY APPROVALS, ORDINANCES, AND CODES; & (4) THE STATE <br />BUILDINGIPLUMBING CODES AND REGULATIONS. <br />I UNDERSTAND THAT THE PERMIT WILL EXPIRE, AND BECOME NULL AND VOID IF <br />WORK IS NOT STARTED WITHIN 180 DAYS, OR IF WORK IS SUSPENDED OR <br />ABANDONED FOR A PERIOD OF 180 DAYS ANYTIME AFTER WORK HAS <br />COMMENCED; AND, THAT I AM RESPONSIBLE FOR ENSURING THAT ALL <br />REQUIRED INSPECTIONS ARE. REQUESTED IN CONFORMANCE WITH THE STATE <br />BUILDJIVG CODE. <br />APPLICANTS SIGNATU IDATE <br />FEE STATE SURCHARGE TOTAL PAID l 5D <br />S.\B &Z\Pe rinits \Pl t.i nx app 2 <br />