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Property Owner/Customer:
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Job Location:
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*
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Contractor's Phone:
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*
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Contractor:
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*
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State License#:
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*
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City License#:
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*
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Description of Work:
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*
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Work Type:
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Enter the number of the various fixtures to be connected below:
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| Water Closets: |
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| Bathtub: |
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| Lavatory: |
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| Kitchen sink/disposal: |
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| Dishwasher: |
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| Laundry tray: |
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| Clothes washer: |
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| Water heater: |
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| Urinal: |
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| Drinking fountain: |
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| Shower: |
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| Floor sink/drain: |
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| Slop sink: |
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| Gas system (no outlet): |
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| Water piping/treating: |
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| Water Interceptor: |
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| Vacuum breakers/blackflow: |
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| Lawn sprinkler system: |
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| Sewers: |
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| Cesspool: |
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| Septic tank & pit: |
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| Other fixtures: |
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CONTRACT AMOUNT: |
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Other Details:
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THIS IS A PLUMBING APPLICATION ONLY!
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To become a permit, this application must be
completed with the correct information. It is suggested that you call the
Building Department to verify fee amounts. Failure to make proper
payment will result in suspension of permit issuance.
I have completed this application with the correct information and I understand
the procedures of this permiting system. Enter your Signature Code supplied by
the Building Dept. below, then submit application.
*
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Please print a copy before clicking submit
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