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PERMITS - Plumbing Permit Application - Hurricane Repair - NO CHARGE PERMIT

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DATE OF APPLICATION

Date of Application*

MonthDay Year,

OWNER INFORMATION

Owner Name*

Owner Address*

Owner Phone Number*

Phone Area Code-Phone 3-Phone 4 ext Extension

Owner Email*

CONTRACTOR INFORMATION

Contractor Name*

Contractor Address*

Contractor Phone Number*

Phone Area Code-Phone 3-Phone 4 ext Extension

Contractor Email*

DESCRIPTION OF JOB

Residential or Commerical

Residential

Commerical

Description of Job*

NUMBER OF CONNECTIONS

# of Disposals

# of Grease Traps

# of A/C

# of Washing Machines

# of Refridgerators

# of Drink Fountains

# of Hose Bibs

# of Water Heaters

# of Water Lines

# of Water Closets

# of Lavatories

# of Bathtubs

# of Sinks

Please Do Not Complete The Following Field

# of Sewers

# of Showers

# of Floor Drains

# of Floor Sinks

# of Dishwashers

# of Urinals

# of Outside Sewer Connections

# of Outside City Sewer Inspections

Any additional information you want to provide?

Additional Information

The City of Sulphur, Louisiana

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