Job Address:
Applicant Name: Phone:
Applicant is the: Contractor* Homeowner**
*
A Special Plumbers License with the City of Cookeville is required. $50 annual fee based on calendar year.
**If applicant is the homeowner, he/she must read and sign a Homeowner Affidavit.
Project Information: Existing Commercial Existing Residential
New Commercial New Residential
Property Owner:
Address:
City, State, Zip Phone:
Is this property on:
Sewer
Septic
Indicate number of fixtures (each)
Bathtub Water Heater Sewer Connection
Toilet Laundry Sink Sewer Repair
Shower Washer Backflow Preventer
Urinal Mop Sink Grease Trap
Kitchen Sink Lavatory Floor Drain
Dishwasher Drinking Fountain Water Line Connection
Garbage Disposal Swimming Pool Ice Machine/Maker
Bar Sink Outside Faucet Whirlpool
Bidet Clinical Sink Three Compartment Sink
Sump Pump Sewage Ejector Pump Septic Tank Connection
Water Connection to Carbonated Beverage Dispenser
Total Fixtures:
Other (Please Specify)
Permit Fee Calculation: $50 base fee + $5.00 x Total Fixtures:
=
You may also use the following link to calculate the fee for this application.
http://www.cookeville-tn.org/codes/calculators/plumbing-permit-calculator
Applicant Signature: Date:
Plumbing Permit
Application
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0
$ 0.00
$ 50.00
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