CITY OF GRIMES Application for Permit to Construct Plumbing State License No. _________________________ Job Address ______________________________________________________________________________________________ Owner ___________________________________________________________________________________________________ Owner Address ____________________________________________________________________________________________ The undersigned hereby makes application for a permit to perform work, as described hereon, at the above address. The following questions must be answered: This is a new __________ existing ___________ structure and is used as _____________________________________________ If a dwelling, state number of units ________________________________ Signature of Applicant ______________________________________________________ Date ___________________________ Company Name ___________________________________________________________ Phone __________________________ Company Address ________________________________________ City __________________ Zip Code __________________ NOTE – READ CAREFULLY *Except for Permit No., all portions of this form shall be completed by the applicant. *Stamped signatures will not be accepted. *This permit will expire if work is not commenced within 60 days or if work is abandoned for 120 days. *All work must be inspected. *It is the responsibility of the applicant to call for the inspection – Phone 986-3036. ***24 hour notice for inspections required. *Permits are not transferable–all work must be performed by the applicant or their employees. *No plumbing work shall be concealed or covered until approved by the inspector. *Applicant is assumed to be knowledgeable of the applicable Plumbing codes – any questions should be resolved prior to installation. Description of work No. Fee Total Water Service: Domestic Install ____ Change ____ Repair ____ 4.00 Water Piping openings (first $3.00) 3.00 Water Service fire. Install ____ Change ____ Repair ____ 6.00 Water Main – Private Install ____ Change ____ Repair ____ 6.00 Sewer, Private Sanitary __________ L.F. Storm __________ L.F. 3.00 Septic Tank, etc. Install ____ Change ____ Repair ____ 15.00 Reconstructions: Drains ____ Stacks ____ Vents ____ 3.00 Street Bonds for: Water ____ Sewer ____ Storm ____ Tapping fee for: Water ____ Sewer ____ Spas ____ Hot Tub ____ 10.00 Swimming Pool 100.00 Residential: No. Fee Total Residential: No. Fee Total Flat fee for new residential – Includes storm sewer 75.00 Flat fee for additions/remodel or basements 35.00 (one and two family dwelling units and townhouses) (*residential only) Description of Work: Garbage Disposal Unit 2.00 Fixtures for first fixture or fixture opening 6.00 Description of Work: For each additional fixture or opening 2.00 Automatic Washing Machine 2.00 Closets 2.00 Dishwasher 2.00 Urinals 2.00 Garbage Compacter 2.00 Lavatories 2.00 Ice Machine 2.00 Sinks 2.00 Bar (each opening) 2.00 Tubs 2.00 Soda Fountain (each opening) 2.00 Hot Water Heater 2.00 Air Conditioning (waste water opening) 2.00 Floor Drains 2.00 Compressors 2.00 Garage Drains 2.00 Sump Pump 2.00 Refrigerator Drains 2.00 Downspout (each) 2.00 Drinking Fountains 2.00 Water Softener 2.00 Floor Sink 3.00 Reconstruction (no fixture) 2.00 PTR Valve 3.00 Separate Water Service Inspection 5.00 Cond. Drain 3.00 Vacuum Breaker 3.00 Auto. Wash Drink 3.00 Sett Basin 3.00 Area Drain 3.00 Ind. Waste 3.00 Hydrant 3.00 Sew. Ejector 3.00 Grease Traps 3.00 Irrigation Meter 3.00 Base Fee 5.00 City of Grimes __________________________________________ Date _______________ Total _____________ Building Official.