No.
APPLICATION FOR PLUMBING PERMIT
CITY OF ARKADELPI
-
IIA
BUILDING DEPARTMENT
700 CLAY STREET
ARKADELPHEA, ARKANSAS 71923
PHONE (870) 246-1818 •
FAX
(870)
245-3553
JOB
ADDRESS:
PROPERTY USE
APPLICANT:
FIRM NAME:
WORK TO BE DONE:
FIRM'S ADDRESS:
OWNER:
CITY:
STATE:
ZIP:
OWNER'S ADDRESS:
PHONE:
(
CITY:
STATE:
ZIP:
LICENSE NO.:
PHONE:
(
)
I
EXPIRATION DATE:
QUANTITY DESCRIPTION
QUANTITY DESCRIPTION
Water Closets
@$3.O0 ea.
=
Total Carried Forward
Utility Sinks
($3.00 ea.
=
Sewer Connections
(ä$10.0O ea.
=
Bath Tubs
(ä$3.00 ea.
=
Septic Tanks
@$ 10.00 ea.
=
Showers
_j$3.00
ea.
=
Clearance
i$10.00 ea.
=
Sinks/Basins
$3.00 ea.
=
Gas
$io.00 ea.
=
Garbage Disposals
($3.00 ea.
=
Backflow Prevention
Water Heaters
@53.00 ea.
=
Device (RPZ)
___
@,$3.00 ea.
=
Dishwashers
___
@,$3.00 ea.
=
Other (describe):
Drinking fountains
($3.00 ea.
=
($3.00 ea.
Water
$3.00 ea.
=
(ä$3.00 ea.
=
Floor Drains
_....@$
3
00
ea.
=
Washing Machine
@$3.00 ea.
=
Non-residential
surcharge
=
Urinals
($3.00 ea.
=
(50
per $1,000 contract/job amount)
Application
Fee
=
$10.00
(Minimum
Permit Fee $5.00)
Column Total Amount
=
TOTAL AMOUNT
=
Issuance of this permit shall be in accordance with Ordinance 0-10-02. Refunds will not be granted for invalid
permits as set forth in Section 7 Permit will expire
if
work is not commenced within 180 days
of
issuance or
if
work is suspended or abandonedfor 180 days after work is commenced. An extension may be requested in writing
with justifiable cause demonstrated.
Signature of Plumber or Authorized Agent
Approved by
Date
Receipt of
is acknowledged for above permit.
Check #
Cash
Receipt#
Receipted by
Date
Submit
click to sign
signature
click to edit
click to sign
signature
click to edit
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