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2. 
3. City of Laconia, NH
   Dept. of Public Works
4. NOTE THAT QUESTIONS FOLLOWED BY AN ASTERISK * REQUIRE AN ANSWER IN ORDER TO SUBMIT YOUR APPLICATION
6. Today's Date*
   Today's Date
8. Your Name*
9. Your Company's Name
11. Your Phone Number*
12. Your Email Address*
14. Are you a Master Plumber licensed by the State of NH?*

    1. Yes
    2. No
15. Does the Laconia DPW have a copy of your current license on file?*

    1. Yes
    2. No, I will submit it with my payment
16. PLU Master Number
18. Property Owner's Name
19. Work Site Street Address*
    include an apartment number if applicable
21. Does this work provide for an additional tenant?*

    1. Yes

    1. No
25. Fixtures to be added/changed
    Type in the number of fixtures for each group. If you skip a question, it is considered zero.
27. Bath Groups
    ($30 each)
29. Lavatories
    ($5 each)
31. Water Closets
    ($20 each)
33. Tubs
    ($10 each)
35. Showers
    ($10 each)
37. Urinals
    ($5 each)
39. Sinks
    ($10 each)
41. Washer
    ($15 each)
43. Dishwasher
    ($10 each)
45. Floor Drains
    (each 2" trap costs $10; each 3" trap costs $15; each 4" trap costs $20)
49. TOTAL COST*
51. I wish to connect the above fixtures with the public sewer.
53. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
55. Electronic Signature*

57. Your application cannot be approved until we receive payment in full. The cost of the plumbing permit can be determined by adding the price of each fixture. We cannot accept credit card payment online or over the phone at this time. Checks (written to the "City of Laconia") can be dropped off at the DPW during business hours (Mon-Fri 7:30am-4:00pm) or can be mailed to: Laconia Department of Public Works, 27 Bisson Ave., Laconia, NH 03246. Include a copy of your current plumbing license to ensure we have your information on file.

61. Inspection by
63. Approved by
Leave This Blank:


66. Submit

* indicates a required field