Plumbing Permit Application Plumbing Permit Application Job Address:(Required)Parcel Number (Optional):Project Description:(Required)PROPERTY OWNERName:(Required) First Last Address:(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone:(Required)Email:(Required) Contractor Please Select if Contractor Business Name:(Required)Address:(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone:(Required)Email:(Required) State Contractor License Number:(Required)Expires:(Required)Base Fee $26.85Please Select One:(Required) State Fee Residential – $6.50 State Fee Commercial – $25.00 Each Res. Unit >1 – $2.00QTYLaundry Tray – $9.40QTYBar Sink – $9.40Lavatory (basin) – $9.40QTYBackflow <2" – $9.40QTYMisc – $9.40QTYBackflow >2" – $20.94QTYPretreatment Interceptor – $17.45QTYAtmospheric Break 1-5 – $8.75QTYRepair/Alt Drain/Venting Pipe – $9.40QTYAtmospheric Break over 5 – $2.15QTYRoof Drain – $9.40QTYBathtub – $9.40QTYSewage Pump – $9.40QTYClothes Washer – $9.40QTYSewer Repair – $9.40QTYDishwasher – $9.40QTYShower – $9.40QTYDrinking Fountain – $9.40QTYSink – $9.40QTYFloor Drain – $9.40QTYSupplemental Permit – $6.98QTYHose Bib – $9.40QTYUrinal – $9.40QTYKitchen Sink – $9.40QTYWater Closet – $9.40QTY3 Compartment Sink – $9.40QTYWater Heater – $9.40QTYWater Piping/Service – $9.40QTYSampling Port – $9.40QTYSignature:(Required)Information contained herein is true and correct. I certify that I am the owner of the subject property, or, that I have been given express permission by the owner of the subject property to submit this application for permit. I understand that the granting of a permit does not authorize me in any way to violate or cancel any of the provisions of state or local law regulating the construction or performance of construction sought under this permit.Date:(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920PhoneThis field is for validation purposes and should be left unchanged.
