Date: Location of work: Commercial Residential

Owner InformationName: Address:City: Postal Code: Home #: Cell #: Email:

Contractor InformationCompany Name: Address:City: Postal Code: Work #: Cell #: Email:Certificate # or T.Q. #: Current Port Moody Business Licence #:

I am applying for a permit for the following fixtures:

Floor Water Heater

Water Closets

Wash Basins

Bath Tubs Showers Kitchen

SinkWash Tubs

Auto Washer

Floor Drains Urinals Dish

WasherRoof Drains

Other Fixtures

Basement

Main

Second

Third

Fourth

Totals

Total number of fixtures: ________________

I hereby agree that all work performed under this permit shall be completed in accordance with the ‘Building & Plumbing Code Administration Bylaw’ of the City of Port Moody.

Applicant’s signature: Print name:

Plumbing Permit Application