BoroughofCollegeville
491E.MainStreet
Collegeville,PA19426
610.489.9208–610.489.6661(fax)
www.collegeville‐pa.gov
PLUMBINGPERMITAPPLICATION
1.PLUMBINGPERMITAPPLICATION
Street,City,State,Zip
ForBoroughUseOnly
ParcelNo. Block&Unit ZoningDistrict
2.IDENTIFICATION
PropertyOwner:_______________________________________________________________________________________
Address:_______________________________________________________________________________________________
CellPhone:_______________________________________OtherPhone:________________________________________
E‐Mail:_______________________________________________________________________________________________
Tenant:_______________________________________________________________________________________________
Address:_______________________________________________________________________________________________
CellPhone:_______________________________________OtherPhone:________________________________________
E‐Mail:_______________________________________________________________________________________________
Contractor:____________________________________________________________________________________________
Address_______________________________________________________________________________________________
CellPhone________________________________________OtherPhone:________________________________________
E‐Mail:_______________________________________________________________________________________________
3.TYPEOFPLUMBINGWORK(Pleasecheckone)
NewAdditionAlterationRepairOther
# Type # Type # Type # Type
Sink Urinal WaterHeater GreaseTrap
WaterCloset IceMaker HoseBib SumpPump
Lavatory Dishwasher LaundryTray WaterSoftener
Shower WashingMachine FloorDrain SewerEjector
Bath DrinkingFountain GarbageGrinder SewerConnection
TotalNo.ofFixtures:Construction/ImprovementCost:PermitFee(SeeFeeSchedule):
SignatureofContractor/Applicant:_____________________________________________Date____________
Bysigningthisapplication,thecontractor/applicantcertifiesthatallinformationgiveniscorrectandthepropertyownerhasauthorized
thework.DepositofcheckrepresentingfeesforthisapplicationdoesnotconstituteapprovaloforgrantingofsamebyCollegeville
Borough.
Validation(ForBoroughUseOnly)
PermitNo.:PermitIssued: PermitFee:CheckNo.: