City of Rocky Mount Plumbing Permit Form

City of Rocky Mount Inspection Services
PLUMBING PERMIT APPLICATION - RESIDENTIAL

Instructions: Complete all pertinent fields, then read the information at the bottom of the form. Click the Submit button to send the information; click Clear to start over.

Applicant Name:

Date:

Project Address:

Subdivision:

Developer:

Telephone:

Property Owner:

Telephone:

Plumbing Contractor:

State License #:

Address:

City:

State:

Zip Code:

Telephone:

Project Supervisor:

Telephone:

Description of Work (Detailed)

Type of work (check all that apply, including quantities of each):

 Water Closet       $11.00

 Bathtub            $11.00

 Lavatory           $11.00

 Sink               $11.00

 Sewer Connection   $11.00

 Water Connection   $11.00

 Floor Drains       $11.00

 Washing Machine    $11.00

 Electric Water Heater      $11.00

 Gas Water Heater           $21.00

 Gas Connection (1st)       $21.00

 Additional Gas Connection  $11.00

 Dishwasher                 $11.00

 Garbage Disposal           $11.00

 Shower Stall               $11.00

 Lawn Sprinkler Backflow    $21.00

 Swimming Pool Fam.         $53.00

New Construction Fees (select one)

Minimum Fee: $65.00	Failure to Obtain Permit: $250.00	Reinspection Fee: $75.00
Extra Inspection Fee: $75.00 (minimum two hour charge after normal working hours)

Total Fees

Comments:

I hereby certify that all the information in this application is correct and all work will comply with the State Building Code and all other applicable State and local laws, ordinances and regulations. The Inspection Department will be notified of any changes in the approved plans and specifications for the project permitted herein. I further understand that this is NOT an authorization to begin work. Work may only commence after approval and issuance of the permit.

Owner/Applicant E-mail Address:
Daytime Phone: