Application for MECHANICAL PERMIT
Building Services Division
1700 Civic Drive ۰ DuPont, WA 98327
P: (253) 912-5217 ۰ F: (253) 964-1455
www.dupontwa.gov
Permit Number:_____________________________________
Application is hereby made for permit to do the following work: □ Commercial □ Residential
□ New Installation □ Addition □ Replacement
DESCRIPTION OF WORK:________________________________________________________________
Quantity Quantity Quantity
Air Conditioner Exhaust Fan Package Heater/ AC
Air Handler Fireplace/Stove Range Hood
Clothes Dryer Furnace Refrigeration
Commercial Hoods Gas Piping Unit Heaters
Duct Work Make-up Air Other __________
Project Address: Parcel Number:
Owne
r of Building: Phone Number: ( )
Mailing Address
(if different from Project address):
Applicant (if contractor, fill out next section): Phone Number: ( )
Add
ress: City: State: Zip:
Contact Person: Email: Phone Number: ( )
Contractor: Phone Number: ( )
Add
ress: City: State: Zip:
State Contractor Number: City Business License:
Project Contact P
erson: Phone Number: ( )
SCHEDULE OF FEES
(OFFICE USE ONLY)
Filing fee $ 30.00
No. of fixtures
Residential______@ $10/fixture $___________
Commercial______@ $15/fixture $___________
Subtotal $___________
Plan Review Fee (Due @ submittal) $___________
(75% of Permit Fee)
Deposit Rec’t #_____________ $___________
TOTAL $___________________
I certify that I am the: □ Owner □ Contractor □ Agent
I hereby certify that I have read and examined this application and state
that the above information is correct. I agree to comply with all City
Ordinances and S
tate Laws, whether specified herein or not.
***By leaving the contractor information section blank, I hereby certify
further that contractors (General or Subcontractors) will not be hired to
perform any work in association with this permit.
Applicant / Authorized Agent Signature Date
Printed Name
click to sign
signature
click to edit
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