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Print Clear PLUMBING PERMIT APPLICATION This document has been designed
City of Muskegon to complete online, print, SIGN, and
mail to the city with all associated
Date 933Terrace St. P.O. Box 536 Permit #
fees. This form IS NOT designed to
Muskegon, MI 49443-0536 be submitted electronically.
(231)724-6758
I. JOB LOCATION
Job Address Has a building permit been issued for this project?
YES NO NOT REQUIRED
Name of Owner/Agent Owner Address
II. CONTRACTOR /HOMEOWNER INFORMATION
Contractor Name License Number Expiration Date
Homeowner
Address(Street & Name) City State Zip Code
MI
Telephone Number Federal employer ID Number (or reason for exemption) MESC Employer Number (or reason for exemption)
( )
Workers Compensation Insurance Carrier (or reason for exemption) Contractor information registered with the City of Muskegon
YES NO
III. TYPE OF JOB
Class of work (check all that apply
NEW BUILDING ADDITION ALTERATION REPAIR
RESIDENTIAL COMMERCIAL INDUSTRIAL OTHER
Description of work
IV. FEE SCHEDULE Enter the number of items being installed. Multiply by the unit price for the total fee.
FEE #ITEMS TOTAL FEE #ITEMS TOTAL
Base Fee (Non-refundable) $35.00 Connection Building Drain
Building Sewers at street $8.00
Fixtures, floor drains, hospital,
Laboratory Devices $8.00 Manholes, Catch Basins $10.00
Stacks, Conductors, Vents $5.00 Sub Soil Drain $8.00
Sewer Ejectors, Sump Pumps $8.00 Inspections Re-inspections $35.00
Sanitary Sewers or Storm
Less than 6" $8.00 Inspections Final $35.00
Over 6" $25.00 Inspections Special/Safety $50.00
Water Service
Less than 2"
$8.00 Inspections Hourly Rate $50.00
2"to 6" $25.00 Plan Review Fee 25%
Over 6" $50.00 Other
Reduced Pressure Zone
Backflow Preventor $10.00
Other
Water Distribution Pipe
¾ " $8.00 Other
1" $15.00 TOTAL FEES
1 ¼ " $23.00
1 ½ " $30.00
2 " $38.00 RECEIVED BY APPROVED FOR ISSUE BY
Over 2" $45.00
V. HOMEOWNER AFFIDAVIT
I hearby certify the electrical work described on this permit application shall be installed by myself in my own home which I am living or am about to occupy. All
work shall be installed in accordance with the electrical 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 electrical inspector and assume responsibility to arrange all necessary inspections.
VI. APPLICANT SIGNATURE
Section 23a of the state construction code act of 1972, 1972 PA 230, MCL 125.1523a, prohibits a person from conspiring to circumvent the licensing
requirements of this state relating to persons who are to perform work on a residential building or a residential structure. Violators of section 23a are
subjected to civil fines."
Signature of Licensee or Homeowner(Homeowner Date
signature indicates compliance with Section V)
P7/06