2. 

3. CITY OF ELLISVILLE

   1 Weis Avenue

   Ellisville, Missouri 63011

   Phone: 636-227-9660  *  Fax: 636-227-9486

   PLUMBING PERMIT

5. Date:
   Date:
8. Permit #:
10. Project Address:*
12. Lot #:
13. Subdivision:
15. Description of Work:*

17. Contractor Information:

19. Company Name:*
21. Main Phone #:*
22. Fax #:
23. Contact Cell #: *
25. Company Address:*
27. City:*
28. State:*
29. Zip Code:*
31. Contact Email:*
33. Ellisville License #:*
34. St. Louis Co. License #:*
35. St. Louis Co. Bond Exp. Date:*
    St. Louis Co. Bond Exp. Date:

39. Inspections:

41. Water Service Pipe Repair, Alteration, or New Service
43. Ground Rough Inspection
45. Rough Inspection
47. Final Inspection
49. Other Inspection (specify):

53. Please list quantity for each fixture to be installed:

55. Automatic Washer Drain
56. Future Fixture Outlets
57. Sinks
58. Backflow Preventer
60. Garage Traps
61. Bath Tubs
62. Sump Pump
63. Garbage Disposal
65. Tee Head
66. Closets
67. Grease Traps
68. Urinals
70. Dishwasher
71. Water Meter
72. Water Heater
73. Drinking Fountains
75. Lavatories
76. Floor Drains
77. Showers
78. Stack Replacement
80. Other
81. Other Description

    Please Add Description for here

84. Total number of Fixtures:

88. ~ Office Use Only ~

    Fees:

90. 
    

    Plumbing Permit .......... $12.00	Ground Rough Inspection .......... $55.00
    Rough Inspection .......... $55.00	Final Inspection .......................... $55.00
    Fixtures ......................... $2.50 (each)

92. Other Charges: $
93. Other Charges Description:
95. Total Due:
96. Breakdown of Total Due:

    Permit Type:

    Total Fixture(s):

    Inspection Type(s):

    Other Charges:

    Total Amount Due:

    
    

98. Approved by:
100. Date:
     Date:

102. Once your permit has been approved, you will be contacted via email with the amount due and given payment options.

105. Version: 01/17/2020

Leave This Blank:


107. 1. Receive an email copy of this form.
108. Email address

     This field is not part of the form submission.

109. Submit

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