Mechanical / Plumbing Permit Application - City Of Auburn - 2015 Page 2
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2MECHANICAL (indicate the number of new and/or relocated fixtures in the box to the left)
A/C / Heat Pump ≤ 10,000 CFM
Rooftop Unit ≤ 100,000 BTUs
Compressor >1M-1.75M BTUs
A/C / Heat Pump > 10,000 CFM
Compressor > 1.75M BTUs
Rooftop Unit >100-500K BTUs
Boiler ≤ 100,000 BTUs
Evaporative Cooler
Rooftop Unit >500K-1M BTUs
Boiler >100-500K BTUs
Fans - Stationary
Rooftop Unit >1M-1.75M BTUs
Boiler >500K-1M BTUs
Floor Furnace
Rooftop Unit > 1.75M BTUs
Furnace ≤ 100,000 BTUs
Boiler >1M-1.75M BTUs
Suspended Heater
Boiler > 1.75M BTUs
Furnace >100,000 BTUs
Vents: Non-Heating/Non-AC
Compressor ≤ 100,000 BTUs
Gas Piping (# of outlets)
Vents: Hood System: Type______
Compressor >100-500K BTUs
Incinerator: Domestic
Water Heater (Gas)
Compressor >500K-1M BTUs
Incinerator: Commercial/Industrial
Total Number of Fixtures:
PLUMBING (indicate the number of new and/or relocated fixtures in the box to the left)
Bathtub
Modular Building Connection
Water Service
Clothes Washer
Rainwater System (# of drains)
Other:
Dishwasher
Sink: Kitchen/Bath/Laundry
Other:
Hose Bibb
Shower / Tub Combo
Other:
Lawn Sprinkler System
Toilet
Other:
Medical Gas Piping (# of outlets)
Water Heater (Electric)
Total Number of Fixtures:
BACKFLOW – PLUMBING (indicate the number of new and/or relocated fixtures in the box to the left)
Hot Water Tank /Boiler ≤2” >2”
Coffee Machine ≤2”
>2”
Soda Machine ≤2”
>2”
BACKFLOW – PREMISE
Please complete the Utility Permit Application
APPLICANT REPRESENTATIVE
(if not listed on page 1)
Owner
Contractor
Architect
Engineer
On behalf of:
Company Name: _________________________________________ Representative Name: ____________________________________
Address: _______________________________________________ City: ____________________ State: _________ Zip: __________
Email:________________________________ Phone:______________________________________ Fax:_______________________
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.
SIGNATURE
PRINTED NAME
DATE
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