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QTY Fixtures QTY Shower Sink - Floor Sink - Kitchen Sink - Slop Sink - Miscelleanous Soil/Sand Separator Drinking Fountain Sprinkler Stub Sump Pump Urinal Vacumm Breaker Water Closet (Toilet) SFR Duplex Townhouse Water Heater Commercial Water Service Line Commercial Sub Total Issuance Fee $20.00 Total Fee New Addition Change-out Miscelleanous Fixture Tenant Improvement Remodel Contractor Address Property Owner Address (If different than job site address) Contractor Name Clothes Washer Backflow Preventer Bathtub Work Description Multi-Family ALL BLOCKS ARE REQUIRED INFORMATION Property Owner Phone JURISDICTION of the CITY of KALISPELL, Montana Plumbing Permit Application FAX (406) 758-7739 Property Owner Name PHONE (406) 758-7730 Job Site Address Dishwasher Domestic Water Tap Expansion Tank Please email or fax the completed form Eyewash Station Fire Line Size: Class of Work Check One Use of Building Check One Issue Date Signature Hose Bibb Ice Machine Laundry Tub Lavatory (Bath Sink) Lift Station Plumbing fee is calculated @ $8.00 per fixture EMAIL: Business name (for commercial only) Fixtures Floor Drain Gas Oulet Grease Trap Property Owner Email Contractor Phone Contractor Email Boiler