HomeMy WebLinkAbout4530 200th Ave Ne_BLD6436_2025 RESIDENTIAL PLUMBING APPLICATION
Community and Economic Development
City of Arlington • 18204 59th Ave NE • Arlington, WA 98223 • Phone (360) 403-3551
This application is for new, repaired, altered or replaced plumbing installation for existing residences. Please fill out
all pages of this application and include all information.
The City of Arlington does not require a permit to stop leaks or clear stoppages, unless the piping is repaired, altered
or replaced.
Type of Permit: ï² New Installation ï² Addition ï² Alteration ï² Repair
Property Address: Project Valuation:
Lot #: Parcel ID No.: Preferred Contact: ï² Owner ï² Contractor
Project Description:
Owner Name: Home No.:
Email Address: Cell No.:
Mailing Address: City: State: Zip:
Contractor Name: Office No.:
Email Address: Cell No.:
Mailing Address: City: State: Zip:
L&I Contractor License Number: Expiration Date:
• All hose bibs required to be equipped with Atmospheric Vacuum Breakers per ASSE 1019
• All water supplies at 80psi or greater shall have Pressure Reducing Valves (PRV)
• Cross-Connection-Control may be required
Proposed Interior Water Piping Size: ï² Â½â€ ï² â…â€ ï² Â¾â€ ï² 1â€
Proposed Interior Piping Material: ï² CPVC ï² Brass ï² Copper ï² PEX-AL-PEX ï² PEX ï² Galvanized Steel ï² Other
Proposed Exterior Water Piping Size: ï² Â½â€ ï² â…â€ ï² Â¾â€ ï² 1â€ ï² 1Â½â€ ï² 2â€
Proposed Exterior Piping Material: ï² PVC ï² PE ï² Copper ï² PEX-AL-PEX ï² PEX-AL-PE ï² PEX ï² Other
Proposed Drain-Waste-Vent (DWV) ï² Schedule 40 ABS DWV ï² Copper ï² Galvanized Steel ï² Cast Iron
Material: ï² Schedule 40 PVC DWV ï² Brass ï² Other
Proposed Drain-Waste-Vent (DWV)
ï² Â½â€ ï² â…â€ ï² Â¾â€ ï² 1â€ ï² 1Â½â€ ï² 2â€ ï² 3†ï²4â€
Piping Size:
Residential plumbing permits will be assessed a base fee, fee per unit, and inspection fee (plan
review fee per Table 4-6 may be required for certain permits)
Type of Fixture No. of Fixtures Cost per Fixture Subtotal
Additional Plan Review fees x $ 75.00 =
Alteration/repair piping x $ 15.00 =
Backflow Assembly x $25.00 =
Base Plumbing Fee 1 x $ 25.00 = $25.00
Bath/Shower Combo x $ 15.00 =
Building Main Waste x $ 25.00 =
Clothes Washer x $ 15.00 =
Dishwasher x $ 15.00 =
REV03.2022 Page 1 of 2
Residential plumbing permits will be assessed a base fee, fee per unit, and inspection fee (plan
review fee per Table 4-6 may be required for certain permits)
Drinking Fountain x $ 15.00 =
Floor Drains x $ 15.00 =
Grease Interceptor x $ 75.00 =
Grease Trap x $ 25.00 =
Hose Bibb x $ 15.00 =
Icemaker/Refrigerator x $ 15.00 =
Irrigation – per meter x $ 25.00 =
Kitchen Sink & Disposal x $ 15.00 =
Laundry Tray x $ 15.00 =
Lavatory x $ 15.00 =
Medical Gas Piping ≤ 5 Inlets / Outlets x $ 60.00 =
Medical Gas Piping for each additional Inlet / x $ 5.00 =
Outlet > 5
Miscellaneous – regulated by plumbing code, not x $ 15.00 =
otherwise specified
Pretreatment Interceptor x $ 15.00 =
Re-inspection Fee x $ 75.00 =
Roof Drains x $ 15.00 =
Shower (only) x $ 15.00 =
Sink (bar, service, etc.) x $ 15.00 =
Toilets x $ 15.00 =
Urinal x $ 15.00 =
Vacuum Breakers x $ 25.00 =
Water Heater x $ 25.00 =
MODEL NO.:
Water Heater – Tankless x $ 25.00 =
MODEL NO.:
Permit Fee
Inspection Fee $75.00
Processing/Technology Fee $25.00
Total
I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of
the above-described property will be in accordance with the laws, rules and regulation of the State of Washington.
Signature Print Name Date
FOR STAFF USE ONLY
PERMIT # ACCEPTED BY: DATE STAMP
REV02.2024 Page 2 of 2
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