HomeMy WebLinkAboutMechanical Plumbing 2015.pdf MECHANICAL / PLUMBING
PERMIT APPLICATION
Form updated
January 2015
Physical Address: Mailing Address: Webpage & Email: Phone and Fax:
Auburn City Hall Annex, 2nd Floor 25 West Main Street www.auburnwa.gov Phone: 253-931-3090
1 East Main Street Auburn, WA 98001-4998 permitcenter@auburnwa.gov Fax: 253-804-3114
PROJECT INFORMATION
Circle all that apply: Residential Commercial
Mechanical Plumbing
Project Valuation (do not include cosmetic improvements such as paint and carpet) $ ______________
Permit Number #
Parent Permit #
Job site address: _____________________________________ Zip ___________ Lot # _________
Tenant Name: _________________________________ Parcel # _____________________________
Complex Name: ___________________________________ Building #: _________ Suite # _______
For Condominiums – Building Name: _____________________________________ Unit #________
For Mobile/Manufactured Homes – Park Name: _____________________________ Space # ______
Received:
Scope of Work: __________________________________________________________________________________________________
________________________________________________________________________________________________________________
OWNER CONTRACTOR
Company Name:________________________________________
Check this box if this is the primary contact
Contact Person: ________________________________________
Address: ______________________________________________
City: _______________________ State: ______ Zip: _________
Phone: ______________________ Fax: ____________________
E-mail: _______________________________________________
Company Name:______________________________________
Check this box if this is the primary contact
Contact: ________________________ Phone: ______________
Address: _____________________________________________
City: _______________________ State: ______ Zip: _________
E-mail: ______________________________________________
City of Auburn Business License #: BUS__________________
Washington State Lic.#: ________________________________
ARCHITECT ENGINEER
Company Name:_______________________________________
Check this box if this is the primary contact
Architect: ____________________________________________
ID#: _________________________ Exp. Date: ______________
Address: _____________________________________________
City: _______________________ State: ______ Zip: _________
Phone: _____________________ Fax: _____________________
E-mail: ______________________________________________
Company Name:_______________________________________
Check this box if this is the primary contact
Engineer: ____________________________________________
ID# _____________________________ Exp. Date: __________
Address: _____________________________________________
City: _______________________ State: ______ Zip: _________
Phone: _____________________ Fax: _____________________
E-mail: ______________________________________________
MECHANICAL (indicate the number of each new and/or relocated fixture type in the box to the left of the fixture)
Air Conditioner/Heat Pump Gas Cook Top Rooftop Unit BTUs: _______
Fans – stationary, whole house Gas Dryer Vents/Single Ducts
Fireplace insert Gas Piping (# of outlets) Water Heater
Furnace < 100,000 BTUs Gas Stove/Range Other: _______________________
Other: _____________________ Other: ____________________ Total # of Fixtures: ___________
PLUMBING (indicate the number of each new and/or relocated fixture type in the box to the left of the fixture)
Bathtub
Toilet
Other: _____________________
Shower/Tub Combo Water Heater Other: _____________________
Clothes Washer Kitchen/Bath/Laundry Sink Other: _____________________
Dishwasher Modular Building Connection Other: _____________________
Hose Bibb Other: ____________________ Total Number of Fixtures
BACKFLOW – PLUMBING (indicate the number of each new and/or relocated backflow in the box to the left of the fixture)
Backflow – soda machine Backflow – coffee machine Backflow – hot water tank
BACKFLOW – PREMISE
P Please complete the Utility Permit Application
APPLICANT
(check one of the following):
Owner Owner’s Agent Contractor Contractor’s Agent If not listed on Page 1:
Name____________________________ Email:________________________Phone:___________________
I certify that I have read this application and declare under penalty of perjury that the information contained herein is correct and complete. I
agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this
city to enter upon the above mentioned property for inspection purposes. I am either the owner of the property on this permit application, the
Washington State registered contractor for the work, or I represent the owner or contractor as signified above and am acting with the
owner’s/contractor’s full knowledge and consent.
______________________________________ ________________________________________ ___________________________
Print Name Signature Date