SCHEDULE B

APPLICATION FOR A PLUMBING PERMIT. TYPE: F YRELINE/ SPRINKLER

APPLICATION DATE:

I hereby make application under the Port Coquitlam Building and Plumbing
Bylaw for permission to construct. repair or alter the following building
or structure and agree to comply with all the requirements of the said
Bylaw and to indemnify and keep harmless the Municipality against all
claims, liabilities, judgements, costs and expenses of whatever kind,
which may in any way accrue against the said municipality in consequence
of, and incidenta2 to, the granting of the Permit, if issued.

BUILDING SITE ADDRESS:

PARTIAL LEGAL DESCRIPTION: Lot #

OURER

Address

City City

Postal Code Telephone Postal Code Telephone

No. of Meters/Items
Meters of fireline
Siamese Connection(s)
Fire Hydrant(s)
Sprinkler Head(s)
Hose Cabinet(s)
Hose Outlet(s)
Wet/Dry Outlet(s)
Stand Pipe(s)

aw we he ee We we we WK ee mw we RR ® Every owner shall give at least 48
“OFFICE USE ONLY hours notice to a Building
* Inspector prior to the start of

*Permit No.: work on the building site.

*

*Zoning:
nt

«Processing Fee Paid:
bd

APPLICANT

*Receipt No.:
*

«Comments ;

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