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2. Permit #__________________________________
4. Meter Pit Size_________________________
5. Service Line Size___________________________
6. Meter Size________________________________
8. OFFICE USE ONLY
12. Water and/or Sewer Installation and/or Alteration Permit
14. Note:
    PLEASE ALLOW UP TO 48 HOURS ISSUANCE OF PERMIT and ALL WORK MUST BE DONE BY A LICENSED MASTER PLUMBER
16. NOTICE: PLEASE READ THE NOTICE TO ALL PLUMBERS ATTACHED
    Notice to all Plumbers
18. Service Address:*
20. Work Type:*
    -- Select One --ResidentialCommercialFire Protection Line

    Please select one
21. Permit Type:*
    -- Select One --New TapDisconnection from the MainTying into Existing Line

    Please select one
23. Description or Purpose of the work:*
    Please provide detail of work
25. Size and Type of Line*
    Please identify the size and type of line
27. Plumbing Company*
28. Master License #*
30. Address*
    Please provide full address of Plumbing Company
31. City*
33. Email Address*
34. Current City License #*
36. Plumbers Name*
37. Contact Phone #*
41. THE APPLICATION FOR THE PERMIT REQUESTED SHALL ONLY BE GRANTED UPON THE FOLLOWING CONDITIONS:
    Applicant agrees that all work shall be done in accordance with the Utility Department Rules & Regulations, City Engineering Standards, and all laws of the State of Montana. See page 2 of the XXXXXXXXXX. Applicant must have a CURRENT State of Montana plumbing and City Business License on file with the Utility Department. It is the CONTRACTORS' responsibility to use OSHA approved shoring techniques. City of Whitefish personnel require proper shoring prior to entering trench for inspection. Master or Journeyman must be onsite. Public Works must perform an inspection. Plumber will map the location of the curb stop (if altered or new) and give to Inspector upon inspection.(Map Paper supplied) Failure to comply will result in no inspection. Inspector: Randy Reynolds 406-253-8602. Tapping Information: Neil DeZort 406-253-4849. Water Department: 406-863-2456 or 2457.
43. Signature:*
    Please type your full name
44. Date:*
    Date:

    Date:
48. UTILITY DEPARTMENT USE ONLY
50. Curb Map______________________
51. Impact Fees Paid_______________________
52. Excavation Permit Issued___________________
54. Sewer On____________________
55. Sewer Off____________________
57. Comments:_____________________________________________________________________________________________________________________________________
59. THE WORK PERFORMED MEETS THE MINIMUM REQUIREMENTS FOR APPROVAL OF INSPECTION
61. Inspection Signature: _______________________________________________________________________ Date: ______________________________
Leave This Blank:


63. 1. Receive an email copy of this form.
64. Email address

    This field is not part of the form submission.

65. Submit

* indicates a required field