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					      SANGAMON COUNTY ZONING AND BUILDING SAFETY DEPARTMENT
                   200 So. 9th St.-Rm. 213-County Complex
                             Springfield, IL 62701
                    (217) 753-6760 * Fax (217) 747-5103
                         Zoning@co.sangamon.il.us
                   PLUMBING PERMIT APPLICATION
  APPLICATION DATE                              PERMIT #
 OWNERS NAME

 PROJECT ADDRESS

 PLUMBING CONTRACTOR
 ILL PLUMBER LICENSE # 0588-                                            NAME ON LICENSES
 ILL PLUMBING CONTRACTORS REG #                                         CURRENT ( ) YES                    ( ) NO
 CONTRACTOR ADDRESS

 PHONE #                                                                MOBILE #
 CONTRACTOR E-MAIL
 PROJECT MANAGER                                                        MOBILE #
 PROJECT MANAGER E-MAIL

IS HOME OWNER DOING THEIR OWN PLUMBING WORK? Y / N (If answered yes then read & fill out the following section)

                       NOTICE REGARDING RESIDENTIAL PLUMBING WORK

   This Notice is being distributed with Residential plumbing permit applications to remind homeowners or make aware of a key
requirement of the Illinois State Plumbing Code. This Code requires all plumbing work, must be performed, by an Individual or Firm,
licensed and registered to perform plumbing work, in the State of Illinois.

  The only exception to this requirement is that homeowners may perform their own plumbing work for a single-family residence.
They are to have the knowledge to perform the plumbing work and they will reside in that residence for at least one year after the
completion of the plumbing work.

  If the homeowner subcontracts the plumbing work, a Plumbing Contractor licensed and registered with the Illinois Department of
Public Health shall install it.

The undersigned agrees to the above requirements:

Signature:____________________________________________________Date:___________________________________________

Address:____________________________________________________________________________________________________

         NUMBER OF FIXTURES BEING INSTALLED, REPLACED OR REPAIRED
         Tubs/showers                           Drinking fountains                     Backflow preventers
        Washing machine                         Grease traps                           Sinks
        Lavatories                              Water closets                          Water heaters
        Urinals                                 Dishwasher                             Sewage ejector
        Sump pump
        Other
FEE: RESIDENTIAL SQUARE FT. X $5.00 X .007                                              Plumbing Upgrade= cost X .007
    _________ X _____ X .007 = _____________                                            MINIMUM FEE- $30.00

COMMERCIAL FEE: COST X .007                                                              Permit Fee $_____________________


OWNER OR AGENT SIGNATURE: _________________________________Date:_________________________