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Location Of Project Number Street City Zip Geocode Assessment Code Each Number Total 1 15.00 $ 2 6.00 $ 3 15.00 $ Bath Tub Lavatory 4 6.00 $ Shower 5 7.50 $ Urinal 6 7.50 $ Water Closet Kitchen Sink 7 $ 3.00 Service Sink Wash Tray 8 0.75 $ Dishwasher Auto. Washer 9 $ 12.00 Car Wash Sump Ice Machine Glass Fill Station Swimming Pool 10 $ 3.00 11 $ 3.00 12 9.00 $ 13 7.50 $ Date Received By Date 14 1.50 $ Description of Work Date Required Name (print) Address,City, State, Zip Telephone Number Email Address Butte - Silver Bow Building Code Department 155 West Granite Street Room 108, Butte, MT 59701 Plumbing Permit Application I hereby make application for a permit to do plumbing work in accordance with Uniform Plumbing Code & Uniform Administrative Code in a building as hereinafter described. Contact Contractor Business License Number Owner Contractor Bar Sink Floor Sink Issuance of permit For each plumbing fixtures or trap or set of fixture on on one trap (including water, drainage piping and backflow protection therefor) For each building sewer and each trailer park sewer Refrig. Drain Single Family / Multiple Family / Commercial / Accessory Building / Public Building / Factory Building / Warehouse Building / New / Alterations / Additions Type of Building Occupancy Coffee Maker List of Plumbing Fixtures Drinking Fountain Dental Lav. Floor Drain Area Drain Room Drain For vaccum breakers or backflow protection devices on tanks, vats, etc. for installation on unprotected plumbing fixtures including necessary water piping - 1 to 5 Over 5, each Total Fees Storm drains and storm drainage For each water heater "NEW" For each gas piping system of 1 to 5 outlets For each gas piping system of 5 or more outlets For installation, alteration or repair of water piping and/or water treatment equipment For repair or alteration of drainage or vent piping For each industrial waste per- treatment interceptor, including trap and vent, excepting kitchen type grease interceptors functioning as fixture traps For each lawn sprinkler system and fire protection system or any one meter, including backflow protection devices, therefor Water heater "replacement" fee Reinspection fee $30 per hour (provided the $30 does not exceed the original fee in which, original fee will be charged) Signature of Applicant Dental Chair Glass Washer Aspirator X-Ray Tank Fountain Drain Other