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2. Tax Parcel Number (11 digits)*
3. Short Plat Number/Subdivision
4. Lot
6. Email Address of Applicant*
7. Job Site Address*
9. Owner*
10. Phone Number*
12. Address*
14. City*
15. State*
16. Zip Code
18. Contractor Name / Business Name
20. Address
22. City
23. State
24. Zip Code
26. Phone Number
27. Fax Number
29. Email Address
30. Current State License and Expiration Date
32. Type of Structure

    1. S.F.R
    2. Attached Garage
    3. Detached Garage

    1. Manufactured Home
    2. Agriculture
    3. Commercial

    1. Industrial
    2. Church/School
    3. Other
34. Explain Other
36. Type of Work*
40. Plumbing Permit Fee (Insert 1 below)
41. Plumbing Permit Fee
    Please insert 1 in the column to the left. Plumbing Permit fee is in addition to the fixtures selected below.
43. Number of Equipment
44. Description & Fees Per Unit
    Each Plumbing Fixture on 1 Trap or a set of Fixtures on 1 Trap (Including water, Drainage Piping and Backflow Protection therefore) - $7.90
    Each Building Sewer and each Trailer Park Sewer - Obtain Permit from Sewer Utility Operator
47. Rainwater Systems - Per Drain (Inside Building) - $7.90
    Cesspool (Where Permitted) and Private Sewage Disposal System - Obtain Permit from Yakima County Health District
50. Water Heater and/or Vent - $7.90
53. Industrial Waste Pretreatment Interceptor including Trap and Vent, excepting Kitchen Type - $13.45
56. Installation/Alteration or Repair of Water piping and/or Water Treating Equipment, (Each) - $7.90
59. Repair or Alteration of Drainage or Vent Piping, (Each Fixture) - $7.90
62. Lawn Sprinkler System on any one Meter including Backflow Protection Devices therefore - $6.75
65. Atmospheric Type Vacuum Breakers Not Included in Item #12 (Up to and Including 5) - $5.65
68. Additional Atmospheric Type Vacuum Breakers Not Included in Item #12 (Not including 1st 5) - $1.20
71. Backflow Protective Device Other than Atmospheric Type Vacuum Breakers 92 inch diameter and smaller) - $7.90
74. Additional Backflow Protective Device Other than Atmospheric Type Vacuum Breakers (Over 2 Inch Diameter) - $16.85
76. Please print and keep this form for your records before submitting.
Leave This Blank:


78. 1. Receive an email copy of this form.
79. Email address

    This field is not part of the form submission.

80. Submit Submit and Print

* indicates a required field