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PLUM BING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS otvNliR ll],ll.tI.:R l)l:1,('ARA I'l()N <br />rplli(nollirrilFrilril\nlrjochlhc ilflli$nlkricivil|'('nfllyol'l(iitrr('lhnolilr'hun(hql(k'llir\(\5(xl) <br />sitlc ). <br />arxl lhrll'ssiott ('orlc: 'l'ltc Cortlr:rclor's l.iccrtsc l.irn' tkrt's rrol o\r'ncr ol'prrr;rcrIy s'lto httikls or irnplovc\ Ilrctc(,11. <br />und wlto conlrucls lirr such ;rrojccls $,ilh il (lrttlraclor(s) |suunl lo lltc (irttltlclor's l.iccttsc l.:rs'1. <br />-l <br />rutt Scclir l c:ls0ll. <br />l)nlr.( )n rrer: <br />DECLARA'I'ION <br />I hcrchy nllirrn unrlcr Jrcrurlty ol'prjury orrc ol'thc lirlkrwirrg rlcclnralions: <br />l.llxrr (ixlc. lirr lhc;rcrlilrrrirrrcc ol'llrc s'ork lirr rvhieh llrc pcrrrril is issttt'rl. <br />l)olit'r' Nttrrrlrcr I rPitcs I <br />a <br />Y* <br />-ililt,',ri' <br />il:' ;,, ri',:[ .;:x[ il;';:;:';w":corrr;xrtsuliorr covcrirgc is slr:rll stth.i'cl :rrt t'rrr;tIr\'('r l(t ttitttitt;rl ;rrurltics and <br />tkrll:rrs (SllX).(XX)1. irr irtklit cosl ol' cottt;rt'tts:tliott. rlrtttt:tgt's its ;ttrtt'irlcd for the <br />:rnd ullortrcy's l'ccs. <br />Applicrurl: <br />ol' tlrc Busincss nnd l'rnfcssions Cotlc. urxl rrry liccrrsc is in lhll lirrcc urxl.clll'cl. <br />l it't'ttst'Ntttttlrtl.it't:ttst' ('l:tsr <br />I )nle: ('ottl nrt'lrlr. <br />c0Ns't'Ruc't'l()N LI NDIN(i A(;uN( l' <br />issuc(l (Scc. .1097. Civ, C.). <br />l-ctrrlcr's Nxtrrc: <br />l.crtrlcr's Atkh css: <br />A I'l'l,lCAN'l' DIiCl,r\ R,\'l'l( )N <br />I hcr.*hy allirrrt urtrlcr' ;tcrtaltl'ol'pcr.jury'onc ol'llrc lirlkrs'irtg tlcclunrliurts: <br />l)crtxrliliorr l'crrrtils-Ashr'slos Nolilicllion l;ctlcr:rl ltcgulnliorrs ('l'itlc.l0. l'rrtl(r) <br />-Rcquirctl <br />l.ctlcr ol' Not ilicirliorr <br />-l <br />ccrlily llrll thc l'ctlcrul rcguhrlions rcglrdirrg usl^*slus rcrrrovallrc rrtrl npplicnhlc lo lltis pro.ic't'|. <br />-l <br />ccrtily llrnl I lurvc rcltl llris npplicnliorr iurl sltlt:ittlirt'ttutliort is t'rttrt't'|. I irgtr:c lo trrtttplv with nll ('ily rrrrrl County <br />:rrrl ('orrrrty lo r.nler u1rcn the <br />*/to/uz0.f <br />ottlinattccs arttl Slirlc l.lws rclllitrg lo lruiltlirrg hcrt'hv lulln)r'ile rcl)r'cscnlirl ivcs ol' tltis ('ily <br />llxrvc rncltl iottctl ;tropcrly lirr <br />Applit'nrrl or Agertl Signulure: <br />l'ernrilee n$nre ( prinl ): _-L{h-ra I )nlr <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underf loor <br />Building Sewer <br />ArealStorm Drain <br />I nterceptor/ CIarif ier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line vlrc-Y?r2 Dk*i *1, <br />Main Drain/Pool Pipinq 6l lz-lz b4*ffi <br />Fill Line/Back Flow l <br />Pool Heate/Gas Line 11,\1AWfr,bwxy /tt .a <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary SewerlCao <br />Back FIow Device <br />Rouqh Plumbinq ll t tl. <br />Final Gas Test \2t ?-\lng DWY, <br />Meter Release ('r \, <br />- <br />FINAL ))4^\1 t9 \w*>,vl <br />Notes Remarks Etc.