HomeMy WebLinkAboutAPPLICATION - 04-00241 - 47 Mill Race Rd - Sewer LineCITY OF REXBURG
APPLICATION FOR PLUMBING PERMIT
OWNER
Name e_r Y
Address Tel. 3 -
Lot Blk. Add.
PLUMBER
Name
Address Tel.
NATURE OF INSTALLATION
Use
Rough Plumbing
Septic Tank
Fixtures
Water Piping
Complete
Sewer
` f
FEES
Plumbing Permit .................... $
Sewer Inspection .................... $
Inspection of Pipe ................... $
Inspection of Fixtures ................ $
04-6614(
Wilomfi
TOTAL $
Received: Date jO aq 6
By
INSPECTOR'S RECORD
DESCRIPTION OF WORK
Bath Tubs
Urinal
Showers
Sink Trap
Laundry Trays
Water Heater
Wash Basin
Other
Toilet
Slop Sinks
Kitchen Sinks
Floor Drain
Drinking Fountains
Lawn Sprinklers
Water Softeners
Dish Washing Mach.
clothes Washer
JUN 2 9 2004
W E
Rp
Y, VA U PAID CASH $ _
CHECK$
�) S
INSP. NAME
Rough Plumbing
Sewer
Other
Finish Plumbing