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EMERGENCY ALERT
OUTDOOR WATER RESTRICTIONS UNTIL FURTHER NOTICE
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PLUMBING PERMIT APPLICATION
Leave This Blank:
Job Address:
*
PROPERTY OWNER INFORMATION
Name
*
Address
*
City/State/Zip
*
Phone
*
Email
Date
*
CONTRACTOR INFORMATION
Business name
Address
City/State/Zip
Phone
Email
Date
Is the Contractor licensed?
Yes
No
Type of Work
*
New Construction
Demolition
Add./alt./replacement
Other:
Category of Construction
*
1 & 2 Family dwelling
Accessory building
Commercial/Industrial
Multifamily
Other
Description of Work
(example: upstairs bath remodel)
*
TOTAL COST OF JOB
*
Fee Schedule - Use Checklist
$25 Min. plus $3.00 per item over 6 items
Description of item
Quantity
Water Closet (toilet)
Bathtub
Lavatory (wash basin)
Shower
Kitchen sink and disposal
Dishwasher
Laundry tray
Clothes washer
Urinal
Drinking fountain
Floor-sink/roof drain/floor drain
Floor Drain
Roof Drain
Sewer line
Water heater
Waste interceptor
Water piping & treating equipment
Water softener
Vents
Cleanouts
Emergency eye wash
Trench drains
Sand & oil interceptor/grease trap
TOTAL # OF ITEMS
* indicates required fields.
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