Plumbing Permit Application

CITY OF MILAN
BUILDING AND CODES DEPARTMENT

1061 South Main Street . Milan, TN 38358
Phone: (731) 686-0774 . Fax: (731) 686-2986
Building Inspector: Byron Burns, bburns@cityofmilantn.com

APPLICATION FOR PLUMBING PERMIT

Application is hereby made to the Building Inspector of City of Milan for the approval of plans, hereby submitted (if requested by Inspector) for the erection of the fence herein described. All provisions of the Building Laws and Zoning Law shall be complied with in the erection of said fence whether specified or not.
BUILDING ADDRESS
(Office will issue address if property does not currently have one)
CLASS OF WORK
New
Alter
Add
Repair
Move
Demolish
PLUMBING

Please enter number of each type of plumbing fixture to be installed in residence
Water Closet
Floor Drains
Lavatories
Urinals
Bath Tubs
Dishwashers
Kitchen Sinks
Slop Sinks
Washing Machine
Outside Faucets
Sewer
Drink Fountain
Trash Disposal
Shower Bath
Hot Water Heater
Ice Maker
Total Fixtures
LLP LICENSE NUMBER
NAME OF OWNER(S)
Phone Number
Please enter a valid phone number.
PRESENT ADDRESS

Street Address

CityState / Province

Postal / Zip Code
CONTRACTOR
CONTRACTOR PHONE NO.
Please enter a valid phone number.
TN REG. NO.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE INFORMATION IS TRUE AND CORRECT AND
AGREE TO COMPLY WITH ALL STATE LAWS AND CITY REGULATED
BUILDING CONSTRUCTION.
Date

MonthDayYear
Date
SIGNATURE
I agree that my electronic signature is the legal equivalent of my handwritten signature.
NOTE:
1. It is the responsibility of the Owner/Contractor to call for all necessary inspections and see that work has passed inspection prior to the work being covered up.
2. All requests for inspections should be made at least 24 hours in advance of required inspeciton.
FIELDS BELOW TO BE COMPLETED BY BUILDING & CODES DEPARTMENT
(City of Milan Building and Code Use Only)

LEGAL DESCRIPTION:
LOT
BLOCK
SUB
MAP
PARCEL
Should be Empty:

CLASS OF WORK

PLUMBING