Plumbing Permit Application Job Address (required) Street Number and Name (required) Unit Number (required) City (required) State/Province/Region (required) Postal/ZIP Code (required) Country (required) 2. Subdivision (required) 3. Owner's Name (required) First Name (required) Last Name (required) Owner's Mailing Address (required) Street Number and Name (required) Unit Number (required) City (required) State/Province/Region (required) Postal/ZIP Code (required) Owners Phone Number (required) Plumbing Company Name (required) Contractor's First Name (required) Contractor's Last Name (required) Contractor's License No. (required) Plumbing Company Mailing Address (required) Street Number and Name (required) Unit Number (required) City (required) State/Province/Region (required) Postal/ZIP Code (required) Plumbing Company Phone (required) Plumbing Company E-mail Address (required) Use of building (required) Residential Commercial Industrial Other Class of work (required) New Addition Alteration Repair Move Remove Describe Work (required) Valuation of Work: $ (required) Application Accepted By Plan checked by Approved for Issuance by Permit Fees Type in the number of fixtures below Water Closet (Toilet) Bathtub Lavatory (Wash Basin) Shower Kitchen Sink & Disposal Dishwasher Laundry Tray Clothes Washer Water Heater Urinal Drinking Fountain Floor - Sink or Drain Slop Sink Gas System No. Outlets Water Piping & Treating Equip Waste Interceptor Vacuum Breakers Lawn Sprinkler System Sewer Cesspool Septic Tank & Pit NOTICE : The Permit becomes null and void if work or construction authorization is not commenced within 180 days, or if construction work is suspended or abandoned for a period of 180 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provision of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. By signing below, I declare, under penalty of perjury in the second degree, that this application has been examined by me. That the statements made herein are made in good faith pursuant to the Town of Gypsum’s Municipal Code, and to the best of my knowledge and belief, are true, correct, and complete. I am attesting that the above listed business is in compliance with all laws of the United States, State of Colorado, and the Town of Gypsum. Also that this business or applicant is not in default of any financial obligation in any manner to the Town except current taxes. I also agree this business will comply with all laws and regulations applicable to such licensed business and avoid all practices or conditions which do or may affect the public health, morals, or welfare. In addition, this licensed business will refrain from operating upon expiration or suspension of this license unless renewed. This business license will be posted and maintained upon the premises in a place where it may be seen at all times. E-Signature of Company Contractor (required) Date of Signing (required) There was a problem saving your submission. Please try again later. Please wait while your submission is being saved... Submitting...Submit Thank you, your submission has been received.
