PLUMBING PERMIT
PLUMBING PERMIT
PLUMBING PERMIT
APPLICATION NO. SP NO. BUILDING PERMIT NO.
DATE OF APPLICATION:
BOX 1 ( TO BE ACCOMPLISHED BY SANITARY ENGINEER/MASTER PLUMBER IN PRINT)
NAME OF OWNER/APPLICANT LAST NAME, FIRST NAME, M.I TAX ACCT. NO.
FIXTURES TO BE INSTALLED
QTY. NEW EXISTING KIND OF QTY. NEW EXISTING KIND OF
FIXTURES FIXTURES FIXTURES FIXTURES FIXTURES FIXTURES
______ □ □ □ WATER CLOSET ______ □ □ □ BIDETTE
______ □ □ □ FLOOR DRAIN ______ □ □ □ LAUNDRY TRAYS
______ □ □ □ LAVATORIES ______ □ □ □ DENTAL CRUSPIDOR
______ □ □ □ KITCHEN SINK ______ □ □ □ GAS HEATER
______ □ □ □ FAUCET ______ □ □ □ ELECTRIC HEATER
______ □ □ □ SHOWER HEAD ______ □ □ □ WATER BOILER
______ □ □ □ WATER METER ______ □ □ □ DRINKING FOUNTAIN
______ □ □ □ GREASE TRAP ______ □ □ □ BAR SINK
______ □ □ □ BATH THUBS ______ □ □ □ SODA FOUNTAIN SINK
______ □ □ □ SLOP SINK ______ □ □ □ LABORATORY SINK
______ □ □ □ URINAL ______ □ □ □ STERILIZER
______ □ □ □ AIR CONDITIONING UNIT ______ □ □ □ SWIMMING POOL
______ □ □ □ WATER TANK/RESERVOIR ______ □ □ □ OTHERS (Specify) ____
___________ TOTAL ___________ TOTAL _________________
NOTE: THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 & 306 OF THE “NATIONAL BUILDING CODE”
BOX 3 (TO BE ACCOMPLISHED BY THE RECEIVING & RECORDING SECTION)
BUILDING DOCUMENTS
SANITARY
WE HEREBY AFFIX OUR HANDS SIGNIFYING OUR CONFROMITY TO THE INFORMATION ABOVE SETFORTH
BOX 6 BOX 7
MASTER PLUMBER SIGNED AND SEALED PRC. REG. NO. SIGNATURE
PLAN & SPECIFICATIONS
PRINT NAME
APPLICANT
ADDRESS
RES CERT. NO. DATE ISSUED PLACE ISSUED
P.T.R. NO. DATE ISSUED PLACE ISSUED
SIGNATURE TIN
BOX 8
SUPERVISOR / IN-CHARGE OF PLUMBING PRC. REG. NO.
WORKS
PRINT NAME
ADDRESS
SIGNATURE TIN