RESIDENTIAL MECHANICAL
PERMIT APPLICATION
Form #F-304
Updated: January 2021
Planning & Development
99 W. 10
th
Avenue, Eugene, OR 97401
P 541.682.5086
JOB SITE INFORMATION AND LOCATION
Job address:
Suite/bldg./apt. no.:
City/State/ZIP:
Tenant/Business:
DESCRIPTION OF WORK
PROPERTY OWNER
Name:
Address:
City/State/ZIP:
Phone:
Fax:
E-mail:
Owner installation: This installation is being made on residential or farm
property owned by me or a member of my immediate family. This property is
not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(1).
Sign here:
CONTRACTOR
Business name:
Address:
City/State/ZIP:
Phone:
Fax:
E-mail:
CCB lic. no.:
Signature:
Contact name:
Contact phone number:
PERMIT NUMBER
FEE SCHEDULE
Description
Qty.
Total
RESIDENTIAL
Vents / Fans
(dryer, exhaust fan,
water heater, hood)
Fuel burning equipment
(woodstove, fireplace
insert, gas furnace, gas-
boiler includes vents,
flues)
All other equipment
non-gas (Electric furnace,
heat pump, air conditioner,
air handler, etc.)
Gas piping system new
or altered (any number
of outlets)
Alterations and additions
to existing duct work.
Attic/crawlspace fans
(Electrical Permit Only)
MECHANICAL PERMIT FEES
Subtotal permit fees
Minimum Permit Fee $97.10
City Administrative Fee (9% permit &
plan review fees)
State surcharge (12% of permit fee +
admin fee)
TOTAL MECHANICAL PERMIT FEE
www.eugene-or.gov/bps
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
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