THIS APPLICATION DOES NOT CONSTITUTE PERMISSION TO BEGIN WORK. IF WORK
IS BEGUN PRIOR TO THE ISSUANCE OF A PERMIT, AN INVESTIGATION FEE IN
ADDITION TO THE PERMIT FEE SHALL BE ASSESSED. THE INVESTIGATION FEE
SHALL BE EQUAL TO THE PERMIT FEE.

LOCATION OF PROPERTY

An application is hereby made for a permit to cover the following work:
New Structure_____ Residential_____ Commercial_____ Remodel___Addition_____ Other_____
No. Baths_____No. Toilets_____ No.Bathtubs_____No. Lavatories(washbasins)_____
Shower_____ Kitchen Sink______ Dishwasher (Y) (N)   Laundry tray_____Clothes Washer_____
U rinal_____Drinking Fountain_____ Gas (Y) (N) Floor Sink or Drain_____ Slop Sink_____
Lawn Sprnk System_____ Sewer_________ Water Heater (GAS) (ELECTRIC).

NOTICE: APPLICANT MUST SUBMIT A LIST OF FIXTURES WITH TYPE OF MATERIALS
TO BE USED SUCH AS PIPE, BRAND NAMES, ETC. A DIAGRAM OF ROUGH-IN WORK
TO BE DONE MUST ALSO BE SUBMITTED.

Explain the current and/or future use of building or space__________________________________
_____________________________________________________________________________

Describe other work to be performed________________________________________________
_____________________________________________________________________________
OWNER__________________ ADDRESS__________________________________________
CONTRACTOR___________________ ADDRESS___________________________________
State Lic. No.___________________________ Bond No._______________________________

*All plumbing work must comply with the latest edition of the Uniform
Plumbing Code as published by the Internation Conference of Building
Officials (ICBO).
THE APPLICANT SHALL BE RESPONSIBLE FOR INFORMING ALL PARTIES INVOLVED,
INCLUDING THE DESIGN PROFESSIONAL, OF ANY CODE NON-COMPLIANCE AS NOTED ON PLANS, INSPECTION REPORTS OR ANY OTHER DOCUMENTS ISSUED BY THE BUILDING OFFICIAL/ INSPECTOR.

I hereby acknowledge that I have read this application and state that above is correct and I agree to
comply with all City of Kirby ordinances, State laws and the Uniform Codes as published by ICBO
regulating building construction.

AUTHORI ZED SIGNATURE _____________________(PRINT)_______________________
COMPANY__________________ ADDRESS_______________________ PHONE________
DATE OF APPLICATION_________________ DATE PERMIT ISSUED_________________
TOTAL PERMIT FEE $__________________________