Plumbing Permit Application

This is an APPLICATION ONLY, no work is to take place until permit has been obtained from City Hall.

Who is Doing the Work*

ContractorOwner

Plumbing Company Name*

You must be licensed with the City of Dickinson

Applicant Name*

First NameLast Name

Owner Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

City Plumbing License Number*

Property Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Project Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Project Type*

ResidentialCommercial

Fixtures*

	Number of Fixtures
Bath Tubs
Showers
Lavatories
Kitchen Sink
Water Closet
Drinking Fountain
Dishwasher
Slop Sink
Floor Drain
Urinals
Washing Machine
Laundry/Garage Sink
Sand/Oil Interceptor
Other
Other

Other

Please provide type of fixture other and the amount.

Other

Please provide type of fixture other and the amount

I hereby certify that I have read and examined this application and know the same to be true and correct. I hereby certify that I have been authorized by the owner to act as his agent in applying for and obtaining this permit. 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 violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. I further apply for a Plumbing Permit and acknowledge that the information above is complete and accurate and this application is not a permit and all work will be performed by myself or my business, a licensed plumber in the State of North Dakota, in accordance with the conditions of the permit, the approved plans and specifications, and the North Dakota State Building Code. I acknowledge that the City is not responsible for any work done pursuant to any permit issued and hereby waive any claims against the City to that effect.

Owner Signature*

Master Plumber Signature*

Date*

Date