Fillable PLUMBING PERMIT APPLICATION (City of Liberty Lake)

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PLUMBING PERMIT APPLICATION (City of Liberty Lake)

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The PLUMBING PERMIT APPLICATION (City of Liberty Lake) form is 2 pages long and contains:

  • 2 signatures
  • 8 check-boxes
  • 55 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Liberty Lake

BROWSE CITY OF LIBERTY LAKE (WA) FORMS

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1/1/2020 Page 1 of 2
All businesses which perform work in the City must have a current Business License. If the business is located
outside of the City, the license must have a City of Liberty Lake Endorsement.
CHECK ONE BOX BELOW TO INDICATE WHO THE APPLICANT IS
Owner’s Name:
Email: Phone:
Address: City, State, Zip:
Contractor’s Business & Owner's Name:
Email: Phone:
Address: City, State, Zip:
WA State Contractor License: Contractor UBI Number:
Project Contact’s Name:
Email: Phone:
Site Specific Information
Project Address:
Are you replacing existing unit(s) one for one? Yes No
Project Description: (please describe the scope of work)
PLUMBING FIXTURES # OF UNITS x COST / UNIT = AMOUNT
Bathtub x $6.00 =
Clothes Washe
r
x$6.00 =
Dishwashe
r
x$6.00 =
Drain x $6.00 =
Drinking Fountain x $6.00 =
Electric Water Heate
r
x$6.00 =
Floor Sink x $6.00 =
Garbage Disposal x $6.00 =
Hydronic Piping x $12.00 + $1.00 per outlet =
Lawn Sprinkler / Back Flow Preventer x $6.00 =
Miscellaneous x $6.00 =
Sewage Ejecto
r
x$6.00 =
Sink x $6.00 =
Showe
r
x$6.00 =
Toilet / Urinal x $6.00 =
Water Softener x $6.00 =
BY SIGNING BELOW, I ACKNOWLEDGE TH
AT IT IS MY RESPONSIBILITY TO ENSURE REQUIRED INSPECTIONS ARE
COMPLETED AND REQUESTED WITH A MINIMUM OF 24 HOURS NOTICE.
Applicant's Signature (REQUIRED) Printed Name Date
PLEASE MAKE CHECKS PAYABLE
TO CITY OF LIBERTY LAKE
SUBTOTAL
PLUS PROCESSING & TECHNOLOGY FEE
$ 40.00
TOTAL PERMIT FEE DUE
Residential Commercial
PLUMBING PERMIT APPLICATION
Liberty Lake Planning, Engineering & Building Services
22710 E Country Vista Drive, Liberty Lake, WA 99019
Phone: (509) 755-6726 Fax: (509) 755-6713
Website: www.libertylakewa.gov
Email: permitcenter@libertylakewa.gov
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1/1/2020 Page 2 of 2
Permit Issuance Option
Would you like to receive your permit / approved plans via email? Yes No
(If yes, please complete the portion below. Once review of your application is complete, we will contact you for credit card payment via phone. You will
be required to print the permit, inspection card, and approved plans for the job site.)
The permit becomes null and void if work or construction authorized by the permit is not commenced within 180 days of
issuance or if construction or work is suspended or abandoned for a period of 180 days at any time after work is
commenced, unless an extension is granted. Issuance of this permit does not give the authority to violate any federal,
state, or local laws or ordinances, or the building code regulating construction. Separate permits (building, plumbing,
mechanical, sewer, water connection, electrical, etc.) may be required for work performed on this site. Additional permits
/plans may be required prior to Certificate of Occupancy issuance. Contact SRCAA at 509-477-4727 and/or visit
www.spokanecleanair.org to ensure compliance with air quality regulations. The applicant shall be responsible for
obtaining additional permits/approvals from affected agencies. By checking the box below, I certify that I have read and
understand all of the conditions contained herein and I have the authority to sign on behalf of the applicant. Additionally, I
certify that my signature included on the permit, if done by electronic means, provides the same understanding and
authorit
y
as if I had si
g
ned the permit in person or writin
g
.
BY SIGNING BELOW, I GIVE MY PERMISSION FOR USE OF MY ELECTRONIC SIGNATURE ON THE PERMIT AND I
ACKNOWLEDGE THAT I UNDERSTAND AND AGREE TO THE TERMS DESCRIBED ABOVE.
Applicant's Signature Printed Name Date
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PLUMBING PERMIT APPLICATION (City of Liberty Lake)

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Completed 3 August 2020

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