Building Department
21630 11th Avenue South, Suite D
Des Moines, WA 98198
(206)870-7576 fax:(206)870-6544
www.desmoineswa.gov
Residential
Plumbing Permit Application
Project Name: Project Address:
Complex/Park Name: Unit/Space Number:
Building Owner
Contractor
Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Name:
Address: City: State: Zip:
Phone:
Fax:
Email:
Email:
WA Contractor License #:
Des Moines Business License #:
Scope of Work:
Type Cost per unit Number of units Total per line
Toilets
Tubs / Showers
Sinks
Water Heaters
Dishwashers
Laundry Trays
Laundry Washers
Whirlpools, Spas, Etc
Hose Bibbs
Gas Piping 1-4 $6.00, over 4 $1.00 each
Other:
Permit Fee
Automation Fee (Required) see Automation Fee Schedule
Total Permit Fee
I hereby certify that I have read and examined this application and know the same to be true and correct, and agree to comply with City ordinances and State laws
regulating the performance of construction. I certify that I am either the owner of the property described on this permit application, the Washington State licensed
Contractor responsible for the work, or I represent the owner or contractor, and am acting with the owner's/contractor's full knowledge or consent.
Print name of Applicant
Applicant's signature
Application expires 180 days from date of application
Permit expires 180 days from date of issuance or last inspection
Date:
Applicant:
Owner
Owner's Agent
Contractor
Contractors's Agent
