Fillable Plumbing Permit Application (City of Wyoming)

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Plumbing Permit Application (City of Wyoming)

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U.S.A. forms for City of Wyoming

BROWSE CITY OF WYOMING (MI) FORMS

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Expiration Date
Expiration Date
State
MESC. Employer ID (or exemption)
FEE # ITEMS TOTAL FEE # ITEMS TOTAL
r.
5.00$
s.
5.00$
a.
80.00$
t.
5.00$
b.
40.00$
u.
5.00$
2. 3.
a. 5.00$
a.
6.00$
b. 5.00$
b.
10.00$
c. 5.00$
c.
20.00$
d. 5.00$
d.
25.00$
e. 5.00$
e.
30.00$
f. 5.00$
f.
35.00$
g. 5.00$ 4.
h. 5.00$
a.
5.00$
i. 5.00$
b.
50.00$
j.
5.00$ 5.
k.
5.00$
a.
60.00$
l.
5.00$
n.
5.00$
o.
5.00$
p.
5.00$
q.
5.00$
NOTE: Any concealed work shall be inspected before being covered
Email
Driver's License No.
Workers Compensation Insurance Carrier (or exemption)
Stacks: Soil, Waste, Vent, Re-Vent
IV. FEE CHART
1.
PLUMBING APPLICATION FEE
(Non-refundable and includes 1 inspection)
Urinal
Address (Street # / Name / Direction)
City
Zip
PHONE: (616) 530-7285 or (616) 530-7286
Federal Employer ID (or exemption)
Installer is (check one) CONTRACTOR HOMEOWNER (See "Homeowner Affidavit" below)
Resident/Business Phone
Homeowner or Business Name where the work is being performed
Master Plumber License No.
State/Local Contractor Registration No.
I hereby certify the plumbing work described on this permit application shall be installed by myself in my own house in which I am living or about to occupy.
All work shall be installed in accordance with the current Michigan Plumbing Code and shall not be enclosed, covered up, or put into operation until it has
been inspected and approved by the Plumbing Inspector. I will cooperate with the Plumbing Inspector and assume responsibility to arrange inspections.
VI. HOMEOWNER AFFIDAVIT
Licensee or Homeowner Name (please print)
Licensee or Homeowner Signature
V. APPLICATION SIGNATURE (Homeowner signature indicates compliance with section VI. below)
1-1/2" Water Distribution
Water Heater
3/4" Water Distribution
Water Service (check one)
WATER DISTRIBUTION PIPE SYSTEM INTERIOR
Over 2" Water Distribution
1-1/4" Water Distribution
2" Water Distribution
EXTERIOR WORK ONLY
This is your permit when approved by the City's Administrative Authority. Make checks payable to "CITY OF WYOMING"
Storm Sewer
1" Water Distribution
Sink, Slop/Service
Laundry Tray, Stand Pipes
Catch Basin, Sump, Roof Drain
Floor Drain
Sink, 3 Compartment Pot & Pan
I. JOBSITE INFORMATION PLEASE PRINT OR TYPE
1155 28TH ST S.W., WYOMING, MI 49509
Permit #
Application Date
CITY OF WYOMING - INSPECTIONS
Section 23a of the State Construction Act of 1972, Act No. 230 of the Public Acts of 1972, being section 125.1523a of the Michigan Compiled Laws, prohibits a
person from conspiring to circumvent the licensing requirements of this state relating to persons who are to perform work on a residential structure.
Violators of Section 23a are subject to civil fines.
Date
SCHEDULE OF PLUMBING EQUIPMENT
EACH ADDITIONAL INSPECTION
ADMINISTRATIVE FEE (work w/o permit)
III. MANDATORY: DESCRIPTION & COMMENTS Give a detailed description of the work to be performed under this permit.
Water Closet
TOTAL FEE
Name
II. INSTALLER INFORMATION
Phone #
Has a building permit been obtained for this project? (check one)
Scope (check one)
Jobsite Contact Phone
Jobsite Contact Person
Use (check one)
Street Address including Suite #
Lot:
City
WYOMIN G
Backflow Preventer
50.00$
Backwater Valve
Bath Tub / Shower
1
Dishwashing Machine
Drinking Fountain
Grease Trap, Oil Separator
60.00$
MEDICAL GAS - LICENSE REQUIRED
Medical Gas Systems
Garbage Disposal
Lavatory
Medical Gas Piping (per outlet)
Sanitary Sewer (check one)
Lawn Sprinkler
60.00$
Sink, Other than for family use
Sink, Kitchen
m.
Refrigerator, Ice Machine, Water
Connected Appliances
5.00$
b.
c.
REPLACE
REPAIR
REMODEL
NEW
NO
YES
COMMERCIAL
RESIDENTIAL
APPLICATION FOR
PLUMBING PERMIT
NOT REQUIRED
REPAIR
NEW
REPLACE
CAPPING
WELL
REPAIR
NEW
REPLACE
CAPPING
SEPTIC
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Plumbing Permit Application (City of Wyoming)

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Completed 17 July 2020

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