Delaware Health and Social Services Division of Public Health Environmental Health Field Services Thomas Collins Building 540 S. DuPont Highway Dover, DE 19901 Phone: 302-744-1220 Fax: 302-739-1957 Sussex County Health Unit 544 South Bedford Street Georgetown, DE 19947 Phone: 302-856-5122 Fax: 302-856-5065 COMMERCIAL ONLY PLUMBING PERMIT APPLICATION (PLUMBING PERMIT TO BE SECURED 24 HOURS BEFORE WORK STARTS) Name of Plumber (Print or Type) ______________________________________________________ Date ____________________ Signature & Licence Number of Plumber ____________________________________________________________________________ Mailing Address: ________________________________________________________________________________________________ Telephone: __________________________________________ Fax Number: ___________________________________________ Builder/Contractor _____________________________________ Property Owner__________________________________________ The following abstract of specification of plumbing with description and plan is submitted for approval: JOB SITE INFORMATION Road Number _______________________ Lot Number ______________________________________________ Road Name _______________________ Nearest Town ____________________________________________ 911 Number _______________________ Kent County or Sussex County ____________________________ Directions to job site, be specific: ___________________________________________________________ _________________________________________________________________________________________________ DESCRIPTION OF PLAN Number of Stories ___________ FIXTURES SOIL OR WASTE PIPE VENT PIPE How Many Size Material Size Material BATH - Water Closet Lavatory Tub/Shower Urinal KITCHEN - 3 Comp Sinks Dishwasher Hand Sinks Food Prep sinks UTILITIES - Ice Maker Grease Traps Floor Sinks Utility Sinks Coffee Machine Drinking Fountain Floor Drains Water Heater Bar sink OTHER - FOR OFFICIAL USE ONLY Types of Inspections Requested: (48 Hour Notice Required) COA NO. ____________ 1. UG PERMIT ISSUED ______________ NO: ______________ 2. RI ________________________________________________ 3. F Plumbing Inspector Doc. #35-05-20/07/02/08