City of Mukilteo
Building Permit Application
Type of Permit:
Class of Work:
New
Repair
Sign
Alteration
Re-Roof
Other
GENERAL INFORMATION
JOB ADDRESS: ___________________________________________ BLDG/SUITE#: _______ PARCEL NO: _______________________
DESCRIPTION OF WORK: ___________________________________________________________________________________
# of SQ. FT. ADDED?______________________ TENANT NAME: ________________________PHONE: ____________________
VALUE OF WORK: _________________________________________________________________LENDER?
Yes No
LENDER NAME: ___________________ ADDRESS: ______________________________________ PHONE: _____________________
PROPERTY OWNER INFORMATION
NAME: _________________________________ PHONE: ____________________(0$,/BBBBBBBBBBBBBBBBBBBBBBBBBBBB_BBBBBB
ADDRESS: ____________________________________________ CITY: __________________ STATE: _____ ZIP: _______________
CONTACT INFORMATION Same as Above If over 4,000 new or added sq. ft., list the design professional here.
NAME: _________________________________ PHONE: ____________________EMAIL: ___________________________________
ADDRESS: ____________________________________________ CITY: __________________ STATE: _____ ZIP: _______________
Addition
Tenant Improvement
Demolition
Building
Mechanical
Plumbing
Commercial
Residential
Combination
Select the one person the City will contact for anything related to this permit:
Property Owner
Contact Contractor
# of
Fixtures
# of
Fixtures
List of Fixtures
Boiler / Heater
Refrigeration
Ducting
Other:
No. of Heads
Range Hood or Exhaust Fan
A/C or Forced Air Systems
# of Alarm Devices
Gas Range
Clothes Dryer Hookups
Gas Piping
Water Heater
Gas Fireplace or Wood Stove
List of Fixtures
SPRINKLER / SUPPRESSION SYSTEM
MECHANICAL PERMIT APPLICATION
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NAME: _________________________________ PHONE: ____________________EMAIL: ____________________________________
ADDRESS: ____________________________________________ CITY: __________________ STATE: _____ ZIP: ________________
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MECHANICAL CONT5$&725 INFORMATION
NAME: _________________________________ PHONE: ____________________EMAIL : ____________________________________
ADDRESS: ____________________________________________ CITY: __________________ STATE: _____ ZIP: _________________
UBI NUMBER: _______________________________ CONTRACTOR LICENSE NUMBER: _______________________________________
PLUMBING CONT5$&725 INFORMATION
NAME: _________________________________ PHONE: ____________________EMAIL: ____________________________________
ADDRESS: ____________________________________________ CITY: __________________ STATE: _____ ZIP: ________________
UBI NUMBER: _______________________________ CONTRACTOR LICENSE NUMBER: _______________________________________
11930 Cyrus Way
Mukilteo, WA 98275
(425) 263-8000
www.mukilteowa.gov
Fire Permits:
Sprinkler Cert. #__________
Fire Alarm Cert. #__________
Fire Main (Underground)
# of
Fixtures
# of
Fixtures
List of Fixtures
List of Fixtures
Urinal
Sink
Drinking Fountain
Floor Drain
Grease Trap
Other:
Water Heater
Dishwasher
Clothes Washer
Toilet
Bathtub / Shower
PLUMBING PERMIT APPLICATION
Backflow Preventer (Inside Bldg)
Other:
Heat Pump
O:\Forms and Brochures\building permit appl
ication form and pp form.pdf rev 06/2018
610 Front St. Mukilteo WA 98275
005269000XXXXX
Decorative and safety upgrades to building facade
0
Joe Varozza
408-656-4562
1.595 M
Joe Varozza (Board President)
jvarozza@sbcglobal.net
610 Front St. Unit 306
Mukilteo
WA
98275
Jessica Malerk
jessicam@j2consultants.com
8425 44th. Ave. W
Mukilteo
WA
98275
Charter Construction inc.
206-382-1900
paul.kitchell@chartercon.com
980 South Harney Street
Seattle
WA
98108
600 479 166
ChartCI171PM
By Sarah Kress at 12:24 pm, Apr 28, 2020
Pollution Prevention Considerations
Mukilteo Municipal Code Section 13.12.080: “No person shall throw, drain, or otherwise discharge, cause or allow others
under its control to throw, drain, or otherwise discharge into the municipal storm drain system and/or surface and ground
waters, any materials other than stormwater…”
This form applies to all projects that require a Planning/Building Permit, without an engineering permit.
By initialing each box below, the applicant is verifying that it is true for the project.
Initials
Pollution Prevention Measures
My site is already developed, with existing vegetation.
Only the project area indicated on the Permit Application will be disturbed.
There will be no dewatering (dewatering is removing of groundwater or surface water from a construction site).
No dirt will be allowed to run off the property, enter the road, storm drains, ditches, streams,
wetlands, or other water bodies.
If dirt
will be moved off the site, all storm drain inlets within 150 feet of the project will have storm drain
inlet protection (also known as catch basin inserts).
My existing, paved or gravel driveway will be the construction entrance.
Any construction-related dirt and debris will be swept off the driveway and put into a trash can.
No pressure washing debris/water will enter the road, storm drains, or waterways.
All soil piles not worked for more than 2 days will be covered with plastic.
Disturbed soil will have temporary cover (such as straw) during the project, when not being worked on.
When the project is complete, disturbed soils will be seeded, vegetated, and/or mulched.
All project waste (pollutants) will be kept off of roads, and out of storm drains, ditches, streams, and wetlands.
Anticipated waste products are identified below.
All erosion control measures, catch basin inserts, and pollutant controls will be removed prior to
issuance of the project’s final permit acceptance.
All wastes will be disposed of properly.
Anticipated waste products for this project include (initial all that apply):
_______ Exposed concrete aggregate waste
water or other concrete wash out waste
_______ Paint and/or Stains
_______ Cleaning solutions or other chemicals
or materials
_______ Solid waste
_______ Pressure washing waste
_______ Soil, rock, or other earthen debris
_______ Other
_______ None
For disposal information on solid waste, hazardous waste, recycling, and facility locations, visit Snohomish County’s website.
https://snohomishcountywa.gov/207/Solid-Waste
SIGNATURE:
1. I understand that the submittal fee & building plan review fee is non-refundable once the review process has begun, whether or not I
choose to withdraw my application. I hereby certify that I have read & examined this application and know the same to be true & correct.
2. All provisions of the Laws and Ordinances governing this type of work will be complied with whether specified herein or not. The granting
of a permit does not presume to give authority to violate or cancel the provisions of any other state/local law regulating construction or
the performance of construction.
3. By signing this application, I authorize employees/agents of the City of Mukilteo to enter onto the property which is the subject of this
application during regular business hours. The sole purpose of entry is to make any examination of the property which is necessary to
process this application.
4. As the project applicant / property owner, I understand it is my responsibility to assure that no soils, wash water, or waste products from
my project enter the storm drain, are washed into the road, or are allowed to enter any water body. It is my responsibility to assure that
my contractors are aware of these requirements.
Contractor/ Owner / Authorized Agent Signature Date
This box for City use only: This form has been reviewed for consistency with the project scope presented in the Permit Application.
Approval Title Date
JM
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04/27/2020
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