2. Date:*
   Date:
3. $100 Filing Fee

5. Requirements & Recommendations:

   • Under the City Building Code Regulations (Chapter 3, Article 3.100, Section 3.110), it is required that an applicant seeking a building permit for a specific location initiate this process by submitting an application. The estimate is based on the location or address listed in this application and must match the location of the building permit application.
   • Staff may recommend to an applicant to file this application even if a building permit is not desired at that time. This is to confirm the actual utility costs and verify information on utilities within an area.
   • Fees associated with the application must be paid before work will begin on the estimate. Failure to pay at time of submittal will result in dismissal.

   Waiving of Fee:

   • A current and accurate estimate, as approved by the City, is already in existence and that estimate is less than six (6) months old.
   • The applicant may provide a written affidavit that service(s) will be provided to the property by other means as approved by the City.

7. APPLICANT INFORMATION:

9. First Name*
10. Last Name*
12. Phone Number*
13. Email Address*
15. Mailing Address*
17. City*
18. State*
19. Zip Code*

21. SITE INFORMATION:

23. NOTE: This estimate is for the extension of City Utilities from the existing mains to the above described site only.

    • All extension and services related fees are due and payable at issuance of the Building Permit.
    • Line extension estimates are based upon existing historic City maps and are subject to change/recalculation based upon actual location and size of distribution piping in the field. Additional charges or refunds may result from these changes.
    • The plumber installing the grinder pump, if needed, shall be responsible for the proper sizing of the pump after the force main system pressure at the City sewer tap is determined.
    • The tap estimate is based upon 5/8” meter, and a 2” pressure sewer service or 4” gravity sewer service.
    • A utility estimate no older than six months is required as the basis for a permit for that work.
25. Type of Applicant:*

    1. Resident
    2. Home Builder
26. Extension For:*

    1. Water
    2. Sewer
    3. Irrigation
27. Dwelling Type:*

    1. Single Family
    2. Two Family
    3. Multi-Family
28. Type of Residence:*

    1. New Build
    2. Existing
30. Street Address for the Site Requiring an Estimate:*
32. Lot:*
33. Section:*
34. Subdivision:*
35. Travis Country Property ID:*
37. Legal:*

38. For precise property data, please consult the Travis County Appraisal District website at https://traviscad.org/propertysearch

40. Special Notes to GIS
42. I HEREBY CERTIFY THAT ALL INFORMATION IS CORRECT
44. 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.
46. Electronic Signature
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field