HomeMy WebLinkAbout17922 AMBLESIDE CT (Bldg #-4125)_25-0100_2026 RESIDENTIAL MECHANICAL APPLICATION
Community and Economic Development
City of Arlington• 18204 59th Ave NE•Arlington,WA 98223 • Phone(360)403-3551
This application is for new, addition, altered or replaced mechanical installation and new or altered gas piping.
Please fill out all pages of this application and include all information.
Type of Permit: ❑ New Installation ❑ Addition/Alteration/Repair Gas Piping
Property Address: ��� C'c ,Project Valuation:
Lot#: Parcel ID No.: WIW,4—�( �` V eferred Contact: ❑ Owner Contractor
Project Description:
Owner Name: me No.:
Email Address: , Xcy Cell No.:
Mailing Address: C i : State: Zip:
Contractor Name: \ ` Office No.:
Email Address: Cell No.:
Mailing Address: +� C ty: State: ( Zip:
L&I Contractor License Number' t� v� Expiration Date:
• New gas piping requires a pressure test hooking to any appliance
• Sediment traps (drips) are required on all gas lines
• Gas lines are required to be supported/secured every 6 to 8 feet
• Proper Combustion air and venting required for all appliances
• A shut-off valve is required within 6 feet of all appliances
Gas Piping Information ❑ Not Applicable
❑ CSST ❑ Brass ❑ Other
Proposed Piping Material:
Black Steel ❑ Galvanized Steel
Proposed Piping Size: ❑ 1/2" ❑ 5/8" 3/a" ❑ 1" ❑ 11/z" ❑ 2"
Distance from Meter to furthest Appliance: Total BTU's of all Appliances:
Residential mechanical permits will be assessed a base fee,fee per unit,and inspection fee (plan
review per Table 4-8 may be required for certain permits)
Type of Fixture No.of Cost per Unit Subtotal Model No.
Units
Additional Plan Review fees x $75.00 =
Air Conditioning Unit<_100 Btu h x $15.00 =
Air Conditioning Unit>100 Btu h x $25.00 =
Air Conditioning Unit>500 Btu/hp x $50.00 =
Air Handling Units x $15.00 =
Base Mechanical Fee 1 x $25.00 = $25.00
Boiler<10013tu h>3h x $15.00 =
REV03.2022 Page 1 of 3
i
ec n 1'0,0-' '-be arse-smod a base fee, fee per unit, rind inspection fee (plan
review per Table-1-8 ma he required for certain permits
Boiler>1 million Btu/h<50hp x $25.00 =
Boiler>1.5 million Btu/h<50hp x $50.00 =
Boiler>100Btu h 3-15h x $15.00 =
Boiler>500Btu h 15-30hp x $25.00 =
Commercial Hoods-Type I x $25.00 =
Commercial Hoods-Type II x $50.00
Diffusers x $15.00 =
Dryer Ducting x $15.00 =
Ductwork(drawings required) x $25.00 =
Evaporative Coolers x $15.00 =
Exhaust Ventilation Fans x $15.00 =
Fire lace Insert Stove x $15.00 =
Forced Air Heat<_100 Btu h x $15.00 =
Forced Air Heat>100 Btu h x $25.00 =
Gas Clothes Dryer x $15.00 =
Gas Fired Air Conditioning Unit<_100 Btu h x $15.00 =
Gas Fired Air Conditioning Unit> 100 Btu h x $25.00 =
Gas Fired Air Conditioning Unit>500 Btu/hp x $50.00 =
Gas Pi in <_5 units x $15.00 =
Gas Piping for each additional unit >5 x $2.00 =
Heat Exchangers x $15.00 =
Heat Pump-Condensing Unit x $25.00 =
Hot Water Heat Coils x $15.00 =
Miscellaneous Appliance-regulated by x $15.00 =
mechanical code,not otherwise specified
Package Units:5 100 Btu >100 Btu x $25.00 $50.00 =
Range/Cook top-Gas Fired x $15.00 =
,Refrigeration Unit 5100Btu h x $15.00 =
Refrigeration Unit>100Btu h x $25.00 =
Refrigeration.Unit>500Btu h x $50.00 =
'Re-inspection fee x $75.00 =
Residential Ran a Hood Fx $15.00 =
Unit Heaters<_100 Btu h x $15.00 =
Unit Heaters>100 Btu h x $25.00 =
'Variable Air Volume Boxes(part of Air x $10.00 =
Conditioning System)
Wall Heaters-Gas Fired x $25.00 =
Water Heater-Gas Fired x $25.00 =
Permit Fee
Inspection Fee $75.00
Processing/Technology Fee $25.00
Total
I hereby certifythat the above information is correct and that the construction on,and the occupancy and the use of
the abovLestribed property will be in accordance with the laws,rules and regulation of the State of Washington.
Si nature Print Name Date
REV2.2024 Page 2 of 3
PRESSURE PIPING SCHEMATIC
COMPLETE FOR GAS PIPING ONLY
❑ SCHEMATIC IS TO SCALE ❑ SCHEMATIC NOT TO SCALE
Show Pipe Size(s) and Length(s) from meter to all appliances
NOTE:Any interior pressure regulators must be indicated
REV2.2024 Page 3 of 3
Snohomish County
Map Title Assessor
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