CITY OF COVINGTON

APPLICATION FOR UTILITIES

PLANNING & BUILDING DIVISION, COVINGTON PUBLIC WORKS

P.O. Box 768, 200 W. Washington Ave., Covington, TN 38019

Phone: (901) 476 – 7191 Fax: (901) 476 - 5056

Location: ______Subdivision: ______Lot : ______

Property Owner(s): ______Phone: ______

Address: ______City: ______State: ______Zip Code: ______

Contractor: ______Phone: ______

Address: ______City: ______State: ______Zip Code: ______

PLUMBING PERMIT

FIXTURE

/ fee / no. / amount / fixture / fee / no. / amount
Permit Fee / $10.00 / 1 / $10.00 / Water Heater / $ 7.50 / $
Bathtub / $ 7.50 / $ / Dishwasher / $ 7.50 / $
Water Closet / $ 7.50 / $ / Washer / $ 7.50 / $
Bath Sink / $ 7.50 / $ / Outside Faucet / $ 7.50 / $
Shower / $ 7.50 / $ / Sewer Inspect / $10.00 / 1 / $10.00
Kitchen Sink / $ 7.50 / $ / $
Other / $ 7.50 / $ / $
TOTAL : $

New Structure:______Existing Structure: ______

NATURAL GAS PERMIT

Application is hereby made to comply with standards set forth in the International Gas Code and the Ordinances of the City of Covington as adopted by the Covington Board of Mayor and Aldermen.

outlet / fee / no. / amount / outlet / fee / no. / amount
Permit Fee / $10.00 / 1 / $10.00 / Grill / $ 7.50 / $
Furnace / $ 7.50 / $ / Logs / $ 7.50 / $
Water Heater / $ 7.50 / $ / Dryer / $ 7.50 / $
Range / $ 7.50 / $ / Gas Inspect / $10.00 / $
TOTAL: $

New Structure: ______Existing Structure: ______

Signature of Authorized Agent: ______

Date: ______TOTAL AMOUNT TO COLLECT: $______

Revised 11/06/16jnolen