Project and Applicant Information
Contractor/Authorized Agent (If not found in the contractor search above)
Owner (If not found in the owner search above)
Plumbing Fixture Types/Quantity
* If applicant is the homeowner, he/she must read and sign a Homeowner Affidavit. Otherwise, Authorized Agent must be listed.
Designated Agent Authorization form required for all projects.
State contractor's license and certificate of insurance and worker's comp required for projects over $25,000.00.
I acknowledge and certify that the information provided on this application is true and complete. Any information not provided on this application may result in an immediate rejection of the permit application.
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to homeowner/builder is responsible to adhere to all existing setbacks, easements, and/or buffer yards located on said property.
The undersigned affirmed that all requirements will be met and all codes will be followed.