HomeMy WebLinkAboutPlumbing Application and Declaration - Homeowner Homeowner Plumbing Permit Application
City of Maple Ridge Updated Sept 2014
11995 Haney Place, Maple Ridge, BC V2X 6A9 Tel: 604-467-7311 Fax: 604-467-7461
permits@mapleridge.ca www.mapleridge.ca
**Effective October 3, 2011, High-efficiency toilets (HETs) or dual-flush toilets will be required in new
residential buildings or when major renovations occur. Whenever urinals are installed, HEUs will be
required.
DATE:
Construction Address Block# Units #’s
Legal Description
Registered Owner Tel
Sub Type: Check One Single Family Dwelling Duplex Commercial/Industrial/Institutional
Tenant Improvement Apartment Townhouse Apartment over Commercial Space
Other, Please specify
Work Type: Check One New Adding Repair Replacing
Is the home going to contain a: Suite Temporary Residential Unit N/A
Toilets # of Floor Drains # of
Bathtubs # of Rooms with radiant/basebrd heat # of
Bathroom Basins # of Sumps # of
Showers # of Urinals # of
Bidets # of Grease Traps # of
Kitchen Sinks # of Roof Drains # of
Dishwashers # of Rough-in piping only Yes No
Bar Sinks # of Number of rough-in fixtures # of
Auto Washers # of Lawn Sprinkler Yes No
Laundry Tubs # of Pool Backwash (water drainage) Yes No
Hot Water Tanks # of Is Piping being Installed? Yes No
Comments:
__________________________________________________________________________________________________
Applicant’s Signature Contact Person
(please print)
Applicant’s Phone Number Contact’s Phone Number
PLEASE TURN PAGE OVER
Homeowner Plumbing Permit Statutory Declaration
City of Maple Ridge Updated Sept 2014
11995 Haney Place, Maple Ridge, BC V2X 6A9 Tel: 604-467-7311 Fax: 604-467-7461
permits@mapleridge.ca www.mapleridge.ca
IN THE MATTER OF AN application for a plumbing permit, I
DO SOLEMNLY DECLARE:
THAT, I am the owner or one of the owners of lands and premises located at:
(Street Address)
THAT, I solemnly declare that said building is a "Single Family Dwelling";
THAT, I reside or intend to reside at the premises described in paragraph 2 and hereby apply for a permit to
do certain PLUMBING work therein;
THAT, the PLUMBING work will not be carried out by anyone other than myself or other owners of the lands
and premises;
THAT, no person shall be paid to assist me in doing the work under this permit;
AND I MAKE this solemn declaration conscientiously believing it to be true and knowing it to be of the same
force and effect as if made under oath and by virtue of the "Canada Evidence Act".
DECLARED before me at the City of Maple Ridge, in the Province of British Columbia.
_________________________________________ _____________________________________
Date Registered Owner’s Signature
_____________________________________
Witness