Form P-4r - Plumbing Permit Application - City Of Columbus
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1Date ___________________________________ Application #___________________________________
C ity of C olumbus | Depar tment of Development | BuildingSer vic es Division | 757C a rolyn Ave nue , C olum bus, O hio43224
PLUMBING PERMIT APPLICATION
FOR 1, 2, OR 3 FAMILY RESIDENTIAL
TYPE OR PRINT ALL INFORMATION
ð
ð 2 FAMILY RESIDENTIAL
ð 3 FAMILY RESIDENTIAL
1 FAMILY RESIDENTIAL
ð
MULTIPLE PERMIT APPLICATIONS SUBMITTED
APPLICATION #
OF
Consideration for the assessment of a single $35.00
Please indicate the total number of applications being
Application Fee will only be made to applications
submitted for the same address at the same time
submitted for the same address at the same time.
¨ New Construction
TYPE OF PERMIT
Building permit number _________________________________
¨ Alter Existing
¨ Addition to Building
ADDRESS OF JOB _______________________________________ City ___________________ Zip Code _________________
Working In Unit(s) # ___________________________________ TAX DISTRICT/PARCEL #_____________________________
Tenant Name(s)_____________________________________ Telephone ( _________ ) ____________________________
CONTRACTOR ________________________________________ Telephone ( ____ ) ______________ ___________________
FAX _______________________________________________ Email ____________________________________________
Street Address ________________________________________ City/State _____________________Zip Code ___________
SIGNATURE OF LICENSED CONTRACTOR OR AUTHORIZED SIGNER ________________________________________________
PRINT OR TYPE NAME ____________________________________ License # ______________________________________ _
PROPERTY OWNER OF RECORD __________________________ Telephone ( ____ ) _____________ FAX ( ____ ) _________
Street Address _______________________________________City/State _____________________Zip Code ___________
________________________________________________________
______________________________________________
SIGNATURE OF OWNER
PRINT OR TYPE NAME
__________________________________________
____________________________________________________________
SOFT ACCOUNT NUMBER
AUTHORIZED SIGNATURE OF ACCOUNT
Sq. Ft. of Coverage
Per 1,000 sq. ft. or portion
TYPE
Multiple
Base Fee
Total
Application
thereof, of coverage
Round up to closet 1000
New
÷ 1000
=
$115.00
+
$ 65.00
+
$35.00 =
X
construction
and additions
X
$ 75.00
+
$35.00 =
Number of dwelling units
Alteration
No Fee
X
$ 40.00
+
Number of dwelling units
Water Heater
=
$65.00
OR B*C
# of AAV
X
$10.00 ea.
or
=
Air admittance Valves (AAV's
whichever is greater
Application Processing fee
$ 35.00
Map Room fee for Address Creation
$ 35.00
Receipt #
Total of fees due
(614) 645-6340. Incomplete information may result in rejection of submittal.
If you have any questions regarding this form, please call:
#P -4R 8/06
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