MECHANICAL APPLICATION AND PERMIT

CITY OF WEST LIBERTY

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

MonthDayYear
Date
Lic #
IA Contractor Reg. #

PERMIT FEES

* residential rates onloy - commercial to be 1.5 times these amounts

~ inspection fee is $30

+ Add $25.00 per every $25,000 of valuation thereafter

Description of Work
Your contract price
Permit Fee
+ Inspection Fee: $30.00
NOTICE: Separate permits are required for building, plumbing, 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

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

MonthDayYear
Date
Approved
Signature of Applicant

Clear
Date

MonthDayYear
Date
A PERMIT MUST BE ISSUED PRIOR TO COMMENCEMENT OF WORK.
Should be Empty: