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Permit No. City of Appleton 100 North Appleton Street Appleton WI 54911 Phone 920 832-6411 Fax 920 832-6464 Key No. Receipt No. Permit Fee PLUMBING PERMIT 30. 00 Penalty Fee Date For Finance Use Only 15520-4404 TO THE PLUMBING INSPECTOR I hereby apply for a permit to do and install the following plumbing on the premises hereinafter described the work to conform to the Wisconsin State Plumbing Code in the performance of which all parties hereto agree to and are bound by said statutes. NAME OF OWNER NUMBER AND STREET TYPE OF PROJECT One Two Family-New Multi-Family-Remodel Commercial-Remodel WATER CLOSETS Est. Cost Comments CLOTHES WASHERS WASH BASINS LAUNDRY TRAYS BATH TUBS WATER HEATERS SHOWER STALLS FLOOR DRAINS SINKS SUMP PUMPS DISPOSALS WHIRLPOOL TUBS DISHWASHERS URINALS GREASE INTERCEPTORS BAR SINKS DRAIN TILE RECEIVERS GARAGE DRAINS SITE DRAINS OTHER This permit is issued to the undersigned upon payment of the permit fee and is hereby granted authority to do plumbing work indicated on the premises and pursuant to this application herein stated and in full compliance with the City Ordinances and State Plumbing Code. Licensed Master Plumber Print License No* Signature of Applicant E-Mail Address Plumbing Contractor Contractor Telephone Number Contractor Mailing Address Plumbing Inspector WI City State Zip Submit Permit REASONABLE ACCOMMODATIONS FOR PERSONS WITH DISABILITIES WILL BE MADE UPON REQUEST AND IF FEASIBLE White Office Yellow Applicant. 00 Penalty Fee Date For Finance Use Only 15520-4404 TO THE PLUMBING INSPECTOR I hereby apply for a permit to do and install the following plumbing on the premises hereinafter described the work to conform to the Wisconsin State Plumbing Code in the performance of which all parties hereto agree to and are bound by said statutes. NAME OF OWNER NUMBER AND STREET TYPE OF PROJECT One Two Family-New Multi-Family-Remodel Commercial-Remodel WATER CLOSETS Est. NAME OF OWNER NUMBER AND STREET TYPE OF PROJECT One Two Family-New Multi-Family-Remodel Commercial-Remodel WATER CLOSETS Est. Cost Comments CLOTHES WASHERS WASH BASINS LAUNDRY TRAYS BATH TUBS WATER HEATERS SHOWER STALLS FLOOR DRAINS SINKS SUMP PUMPS DISPOSALS WHIRLPOOL TUBS DISHWASHERS URINALS GREASE INTERCEPTORS BAR SINKS DRAIN TILE RECEIVERS GARAGE DRAINS SITE DRAINS OTHER This permit is issued to the undersigned upon payment of the permit fee and is hereby granted authority to do plumbing work indicated on the premises and pursuant to this application herein stated and in full compliance with the City Ordinances and State Plumbing Code. Cost Comments CLOTHES WASHERS WASH BASINS LAUNDRY TRAYS BATH TUBS WATER HEATERS SHOWER STALLS FLOOR DRAINS SINKS SUMP PUMPS DISPOSALS WHIRLPOOL TUBS DISHWASHERS URINALS GREASE INTERCEPTORS BAR SINKS DRAIN TILE RECEIVERS GARAGE DRAINS SITE DRAINS OTHER This permit is issued to the undersigned upon payment of the permit fee and is hereby granted authority to do plumbing work indicated on the premises and pursuant to this application herein stated and in full compliance with the City Ordinances and State Plumbing Code. Licensed Master Plumber Print License No* Signature of Applicant E-Mail Address Plumbing Contractor Contractor Telephone Number Contractor Mailing Address Plumbing Inspector WI City State Zip Submit Permit REASONABLE ACCOMMODATIONS FOR PERSONS WITH DISABILITIES WILL BE MADE UPON REQUEST AND IF FEASIBLE White Office Yellow Applicant.

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