TYPE OF WORK
New construction Demolition
Addition/alteration/replacement Other:
CATEGORY OF CONSTRUCTION
1- and 2-family dwelling Multi-family
Accessory building Industrial
Commercial Other:
JOB SITE INFORMATION AND LOCATION
Job site address:
City/State/ZIP:
Suite/bldg./apt. no.: Project name:
Cross street/directions to job site:
Subdivision: Lot no.:
Tax map/parcel no.:
DESCRIPTION OF WORK
2” or greater water service line
OWNER
Name:
Address:
City/State/ZIP:
Phone:
Email:
APPLICANT
Business name:
Contact name:
Address:
City/State/ZIP:
Phone:
E-mail:
CONTRACTOR
Business name:
Address:
City/State/ZIP:
Phone: Plumbing lic.:
E-mail:
CCB lic.: City or metro lic. no.:
Authorized
signature:
Print name: Date:
FEE SCHEDULE
New 1- 2-family dwellings and additions
(includes 100 ft. for each utility connection)
Each additional bath/kitchen
Fire sprinkler ( sq. ft.)
Catch basin or area drain
Drywell, leach line, or trench drain
Manufactured home utilities
Rain Drain Connector (each)
Sanitary sewer (no. linear ft.: 60.00
Storm sewer (no. linear ft.:
Water service (no. linear ft.:
Clothes washer 15.00
Dishwasher 15.00
Floor drain/floor sink/hub
Interceptor/grease trap
15.00
Medical gas (value: $ ________)
Other:
Fee Type Amount
Permit Fee (minimum $60.00)
Plan review ( 25 % of permit fee)
State surcharge (12% of permit fee)
TOTAL PERMIT FEE
This permit application will expire if a permit is not obtained
within 180 days after it has been accepted as complete.
Plumbing Permit Application
City of Tualatin
18880 SW Martinazzi Ave.
Tualatin, OR 97062
Phone: 503-691-3044 Fax: 503-692-0147 www.tualatinoregon.gov
________OFFICE USE ONLY__________
Date received: _____________Permit # ______________________
Date Issued: ______________ By: _____ Receipt: ____________
click to sign
signature
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