Form Center

2. Owner
3. Owner Phone Number
5. Owner Address
6. Job Address
8. Contractor
9. Email Address of Applicant*
   *If preferred method of contact
11. Intended Project:
13. TYPES OF MATERIALS:
15. Drains and Vents:

    1. PVC Plastic
    2. DWV Copper
    3. Galvanized
    4. Cast Iron
    5. Other
16. Sewer:

    1. Clay Tile
    2. Cast Iron
    3. PVC
    4. Other
17. Water Service

    1. K Copper
    2. Ductile Iron
    3. Other
18. Domestic Water Lines:

    1. PVC
    2. Copper
    3. Cross-linked Poly (PEX)
    4. Other
20. If other, please explain:
24. WATER CLOSET
25. Quantity
26. Fee= $3
27. Total
29. SHOWER/BATH/STALL
30. Quantity
31. Fee= $3
32. Total
34. BATH TUB
35. Quantity
36. Fee= $3
37. Total
39. URINAL/BIDET
40. Quantity
41. Fee= $3
42. Total
44. LAVATORIES
45. Quantity
46. Fee= $3
47. Total
49. KITCHEN SINK
50. Quantity
51. Fee= $3
52. Total
54. DISPOSAL
55. Quantity
56. Fee= $3
57. Total
59. DISHWASHER
60. Quantity
61. Fee= $6
62. Total
64. SERVICE/SLOP SINK
65. Quantity
66. Fee= $3
67. Total
69. UTILITY SINK
70. Quantity
71. Fee= $3
72. Total
74. CLOTHES WASHER
75. Quantity
76. Fee= $3
77. Total
79. WATER SOFTENER
80. Quantity
81. Fee= $3
82. Total
84. SUMP PUMP
85. Quantity
86. Fee= $3
87. Total
89. EJECTOR PUMP
90. Quantity
91. Fee= $3
92. Total
94. TANKS
95. Quantity
96. Fee= $3
97. Total
99. CLEAN OUTS- FLAT FEE
100. Quantity
101. Fee= $3
102. Total= $3
104. WATER HEATER (Gas or Electric)
105. Quantity
106. Fee= $6
107. Total
109. FLOOR DRAINS
110. Quantity
111. Fee= $3
112. Total
114. CIRC./BOOSTER PUMP
115. Quantity
116. Fee= $3
117. Total
119. DRINKING FOUNTAIN
120. Quantity
121. Fee= $3
122. Total
124. SODA FOUNTAIN
125. Quantity
126. Fee= $3
127. Total
129. DENTAL CUSPIDOR
130. Quantity
131. Fee= $3
132. Total
134. LAWN SPRINKLER
135. Quantity
136. Fee= $3
137. Total
139. POOL/SPA CONNECTION
140. Quantity
141. Fee= $3
142. Total
144. GREASE TRAP
145. Quantity
146. Fee= $3
147. Total
149. BACK FLOW PREVENTOR
150. Quanitity
151. Fee= $3
152. Total
154. WATER SERVICE
155. Quantity
156. Fee= $6
157. Total
159. SANITARY SEWER
160. Quantity
161. Fee= $6
162. Total
164. TRENCH/OPEN DRAIN
165. Quantity
166. Fee= $3
167. Total
169. GREASE, GAS/OIL SEPARATORS
170. Quantity
171. Fee= $3
172. Total
174. OTHER
175. Quantity
179. ROUGH-IN INSPECTION REQUIRED PRIOR TO CONCEALING WITH INSULATION AND DRYWALL.
181. FINAL INSPECTION REQUIRED AFTER CONSTRUCTION IS COMPLETED, PRIOR TO OCCUPANCY
183. I HEREBY MAKE APPLICATION TO DO AND PERFORM SAID WORK AND CONSTRUCT SAID PLUMBING AS DESCRIBED IN THE FOREGOING, IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS SUBMITTED; AND I AGREE TO COMPLY WITH THE ORDINANCE OF THE CITY OF PONTIAC IN THE PROSECUTION OF SAME.
185. eSign- First Name
186. eSign- Last Name
187. Date
189. Minimum Permit Fee= $10
191. ** Please note that a fee will be required. You may call with a Credit Card Number, send a check/cash, or stop into City Hall to pay for your fee. Your fee total will be sent with the permit.
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193. 1. Receive an email copy of this form.
194. Email address

     This field is not part of the form submission.

195. Submit

* indicates a required field