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<br />MAIL TO: <br />DEPARTMENT OF PUBLIC WORKS <br />COUNTY OF HAWAI‘I <br />PICK UP PHONE # <br />BUILDING DIVISION <br />PLUMBING PERMIT APPLICATION BUILDINGPERMIT# <br />Legal OwnerPhonePlumbing ContractorLicense NoPhone <br />Lessee/TenantPhoneAddressCell <br />PROJECT LOCATION: Email <br />EST COST OF WORK:JourneymanLicense NoPhone <br />EngineeringDateFlood ZoneAddress <br />TYPE OF WORK <br />RESIDENTIALNON-RESIDENTIAL <br />NEWREPAIRGASAS BUILTIRRIGATION <br />NO WORK STARTED <br />ADDITIONSOLARSEWER ABANDONEDCESSPOOLPLUMBING ONLY <br />CONNECTION <br />ALTERATIONOTHER <br />SUPPLEMENT TO M______________________ <br />STRUCTURE CONNECTED <br />PUBLIC SEWER* Wastewater Approval _________________________________________________ <br />TO: <br />Received Electronic Approval <br />*Sewer connection shall be approved by Waste Management prior to backfilling. Failure to notify the division may result in <br />re-excavation for inspection. <br />PRIVATE SEWER CESSPOOL SEPTIC SYSTEM <br />DESCRIPTION OF WORK <br />FEE <br />DETAILS ON BACK <br />DRAINAGE AND WATER SUBTOTAL$ <br />0.00 <br />FUEL GAS SYSTEMSUBTOTAL$ <br />0.00 <br />BASE PERMIT FEE$ <br />10.00 <br />WAIVER$ <br />PENALTY FEE$ <br />CHECK NO.: <br />TOTAL FEE$ <br />READ CONDITION BELOW <br />Permitee is qualified to do the work and possess a valid license pursuant to the provisions of Chapter 444 or 448E of the Hawai‘i Revised Statutes. <br />Permitee is hereby authorized to install the plumbing as shown, in accordance with provisions of the County of Hawai‘i Plumbing code as amended. <br />Per Section 17-18 (f) of the Hawai‘i County Code (“Suspension or Revocation”), the administrative authority may, inwriting, suspend or revoke a permit issued under provisions of this <br /> code <br />whenever the permit is issued in error, or on the basis of incorrect information supplied, or in violation of any ordinance or regulation or any of the provisions of this code. <br />This permit becomes null and void if work is suspended at any time during construction for 120 days or more, or if any work is done on the same building or structure in violation of <br /> the County of <br />Hawai‘i Plumbing Code or State Statutes governing same. <br />Refund request for permit fee paid must be received by the Building Division within 90 days from issue date of this permit. <br />Notification for Inspection is mandatory. <br />I hereby acknowledge that I have read this application and state that the above is correct and aereby acknowledge that I have read this application and state that the above is correct <br /> and agree to comply with all County and State Laws regarding gree to comply with all County and State Laws regarding plumbing. <br />APPLICATION NUMBER <br />PERMITEE’S SIGNATURE ** DATE <br />M <br />JOURNEYMAN’S SIGNATURE**DATE <br />APPROVED BY SIGNATUREDATE <br />**Signature required <br />Ver 6.0 01/18/2012 <br />Hawai‘i County is an Equal Opportunity Provider and Employer <br /> <br />