Plumbing Permit Application

Job Location:

Street Address *

City *

ZIP / Postal Code

Municipality

Property Owner's Name:

Applicant Information

If you are applying for your permit as a homeowner, proceed to the Homeowner Information section below.

Company Name:

Applicant Street Address:

City:

State/Province

Zip/Postal Code:

Contractor Licensee Name:

Contractor's License #:

License Expiration:

Date of Birth:

Federal ID #:

MESC #:or reason for N/A

Workman's Comp:

Phone:

Email Address:

Fax:

Homeowner Information

Homeowner Name:

Homeowner Address:

City

State/Province

ZIP / Postal Code

Homeowner Phone:

Homeowner Email:

Homeowner Date of Birth:

Job Information

Job Information:Is this a new build, addition, or alteration?

Job Building Description:Is the job for a house or accessory building?

Scope of work (optional):

Select Inspections

ENTER NUMBER OF ITEMS TO BE INSTALLED BELOW

Water Connected Fixtures:Quantity- $9.00 Each

Water Line Connections:Quantity- $9.00 Each

Sewer/Septic Connections:Quantity- $9.00 Each

Water Softener System:Quantity- $9.00 Each

Stacks or Vents:Quantity- $9.00 Each

Reverse Osmosis:Quantity- $9.00 Each

Sump Pumps/Ejectors:Quantity- $9.00 Each

Subsoil Floor Drains:Quantity- $9.00 Each

Outside Faucets:Quantity- $9.00 Each

Backflow Preventer:Quantity- $9.00 Each

Do you need any outdoor lines inspected?

NoYes.25 per foot

Lines to be Inspected:

Water LineStorm Sewer LineSanitary Line

Please enter the amount of footage:

License FeeDo you need to register as a contractor or update your license? $15 Fee

Code Compliance

Was your installation started without obtaining a permit? (Red Tag)

Upload Contractor's License

No file chosen

Total with one inspection:

Total with multiple inspections:

Signature: