Building Department
21630 11th Avenue South, Suite D
Des Moines, WA 98198
(206)870-7576 fax:(206)870-6544
www.desmoineswa.gov
Residential
Mechanical Permit Application
Project Name: Project Address:
Complex/Park Name: Unit/Space Number:
Building Owner
Contractor
Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Name:
Address: City: State: Zip:
Phone:
Fax:
Email:
Email:
WA Contractor License #:
Des Moines Business License #:
Scope of Work:
Type Cost per unit Number of units Total per line
Furnace to 100,000 BTU
Furnace larger than 100,000 BTU
Electric Furnace / Unit Heater
Heat Pump
Air Conditioner
Water Heater
Appliance Vents
Fireplace Inserts / Free Standing Stoves
Ranges
Range Hoods
Ventilation / Exhaust Ducts
Gas Piping 1-4 $6.00, over 4 $1.00 each
Permit Fee (Required)
Automation Fee (Required) See Automation Fee Schedule
Total Permit Fee
Applicant:
Owner
Owner's Agent
Contractor
Contractor's Agent
I hereby certify that I have read and examined this application and know the same to be true and correct, and agree to comply with City ordinances and State laws
regulating the performance of construction. I certify that I am either the owner of the property described on this permit application, the Washington State licensed
Contractor responsible for the work, or I represent the owner or contractor as signified above, and am acting with the owner's/contractor's full knowledge or consent.
Print name of Applicant Applicant's signature
Application expires 180 days from date of application
Permit expires 180 days from date of issuance or last inspection
Date:
