PLUMBING APPLICATION AND PERMIT

CITY OF WEST LIBERTY

409 N. Calhoun Street - West Liberty, IA 52776 Phone: (319)627-2418 Fax: (319)627-4847
PLUMBING APPLICATION AND PERMIT
Building Address
Owner
Phone
Plumbing Contractor
Contractor Address
Phone
Date

Month Day Year
Date
Lic #:
IA Contractor Reg. #
QUANTITY
Sinks
Lavatories
Tubs/Showers
Water Closets
Dish Washers
Clothes Washers
Floor Sinks
Water Heaters
Water Softeners
Laundry Tubs
Urinals
Backflow Preventors
please list type and quantity
Grease Traps
Interceptors
Other Fixtures
Building Sewer
Gas Pipe Outlets
Floor Drains

PERMIT FEES

- Add an additional $25 per every additional $25,000 in valuje

* These costs are for residential only - commercial to be 1.5 times these amounts

~ inspection fees is $30; septic tanks shall be separate - $100 base plus time and fringes+

Description of Work
Value of Plumbing Work:
Permit Fee
+ Inspection fee: $30.00
NOTICE: Separate permits are required for building, electrical, or signs. This permit becomes null and void if work or construction authorized is not commenced within 180 days, or if construction or work is suspended or abandoned for a period of 180 days at any time after work is commenced. A License and Permit Bond in the amount of $5,000 is required for all contractors performing work in the City of West Liberty

/ agree to perform the work described herein in accordance with the plans and/or specifications submitted, and with all provisions of the Plumbing Code of the City of West Liberty Total Fee
Total Fee
Permit No.
Date

Month Day Year
Approved
Signature of Applicant

Clear
Date

Month Day Year
A PERMIT MUST BE ISSUED PRIOR TO COMMENCEMENT OF WORK.
Should be Empty:

QUANTITY