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PERMIT APPLICATION Fee Permit Application Center Building # $ County use only PERMIT APPLICATION Fee Permit Application Center Building # $ 12055 Government Center Parkway Mechanical # $ Suite 230 Fairfax, Virginia 22035-5504 Electrical # $ 703-222-0801, TTY 711 Plumbing # $ www.fairfaxcounty.gov/buildingpermits Fire # $ (Please print with black or blue ink only) Appliance # $ Tax Map # Parent # Plan # Job Location Street Address Lot Number Building Floor Suite Tenant’s Name Subdivision Owner Information Name Owner Tenant Address City State ZIP Phone Email Contractor Information (see back for additional contractors) Company Name Same as Owner Address Contractor ID # City State ZIP Phone Email State Contractor’s License # County BPOL # Applicant Information (see back for additional applicants) Name Contact ID # Address City State ZIP Phone Email Designated Mechanics Lien Agent (residential only) Name None Designated Address City State ZIP Phone Email Description of Work Estimated Cost $ House Type Masterfile Number I hereby certify that I have authority to make this application, that the information is complete and correct, and that the construction and/or use will conform to the building code, the zoning ordinance and other applicable laws and regulations which relate to the property. Signature of Owner, Master or Agent Date Printed Name Title COUNTY USE ONLY Licensing Date Permit Issued Date Updated 04/20 Contractor / Applicant Information Company / Applicant Name Address Contractor ID / Contact ID # City State ZIP Phone Email State Contractor’s License # County BPOL # Contractor / Applicant Information Company / Applicant Name Address Contractor ID / Contact ID # City State ZIP Phone Email State Contractor’s License # County BPOL # Contractor / Applicant Information Company / Applicant Name Address Contractor / Contact ID # City State ZIP Phone Email State Contractor’s License # County BPOL # BPOL Exemption I certify that in accordance with Section 4-7.2-3(G) of the Fairfax County Code, a contractor listed on this permit application is exempt from current business license tax based on the prior year gross receipts attributed to their business. Name Contractor Agent Signature Date Routing Information The boxes below, completed by your permit technician, indicate the county agencies and their corresponding addresses that must be approved prior to permit issuance. Zoning: Herrity Building, Suite 250. Zoning will review your project for compliance with the Zoning Ordinance. For permit applications in the town of Vienna, you must start your process at the Vienna town hall, 127 Center Street South. Site Application Center: Herrity Building Information Center, Suite 230. The Site Application Center will ensure your project complies with site-related ordinances and regulations such as the Chesapeake Bay Preservation Ordinance. Cashier: Herrity Building, Suite 236. The cashier accepts most fees in the form of cash, check and all major credit cards. You may incur additional fees during the permit review process, and thus may need to visit the cashier again prior to Log-out. Health Department: Kelly Square, 10777 Main Street, Fairfax. The Health Department reviews permit applications for properties with a well or septic system, food service establishments, hotels, private schools and some daycare centers. Residential Walk-Through: Herrity Building, Suite 252. While you wait, Residential Walk-Thru counter reviews construction plans for small residential projects to ensure compliance with the building code. Building Plan Review: Herrity Building, Suite 324. Building Plan Review ensures construction plans for your large residential or commercial projects meet the provisions of the building code and applicable referenced standards. Wastewater: Government Center, 12000 Government Center Parkway, Suite 358, Fairfax. Wastewater reviews projects which involve public sewer, such as building a new home or adding fixture units in a commercial space. Log-out: Herrity Building Information Center, Suite 230. As your last stop, the technicians in Log-out review your complete submission package, ensure all the appropriate agencies have approved your project and print your permit. Updated 04/20 EQUIPMENT WORKSHEET This worksheet is required to be Permit Application Center 12055 Government Center Parkway submitted with Household Suite 230 Appliance, Mechanical, Electrical Fairfax, Virginia 22035-5504 and Plumbing permit applications. 703-222-0801, TTY 711 www.fairfaxcounty.gov/buildingpermits Parent Permit # The equipment listed on this worksheet is the most commonly requested for each permit type and not inclusive of all work requiring a permit. Equipment not listed herein must be provided in the areas marked “other” or included on attached sheets. Household Appliance Residential: New Replacement QTY DESCRIPTION QTY DESCRIPTION QTY DESCRIPTION QTY DESCRIPTION QTY DESCRIPTION Air Cleaner/Filter Dishwasher Humidifier Shower Water Heater-Electric AC Central System Disposal Ice Maker Sink/Lavatory Water Heater-Gas AC Condensing Unit Exhaust Fan Laundry Tub Smoke Detector (Wired In) Water Heater-Oil Attic Fan Furnace-Electric Lighting Fixtures Solar Energy Equipment Water Treatment Equipment Bathtub Furnace-Gas Oven-Electric Stove-Electric Wood Stove (heater) Ceiling Fan Furnace-Oil Oven-Gas Stove-Gas Other Dryer-Electric Gas Log Prefabricated Chimney Sump Pump Other Dryer-Gas Heat Pump Prefabricated Fireplace Trash Compactor Other Dehumidifier Hose Bibb Pressure Reducing Valve Water Closet (toilet) Other Mechanical Residential: New Replacement Duct Work: Yes No Geothermal: Yes No QTY DESCRIPTION RATING QTY DESCRIPTION RATING QTY DESCRIPTION QTY DESCRIPTION Air Conditioner-Tons Furnace Solid Fuel-MBH Exhaust Fan Gas-Furnace Air Conditioner-Tons Boiler-Water Heater Expansion Tank Gas-Grill Furnace Electric-KW Hot Water Storage Tank Tankless Water Heater Gas-Log Furnace Electric-KW Piping of Equipment Hydronic Piping Gas-Log Lighter Furnace Gas-MBH Other-Tons Indirect HW Heater Gas-Oven-Broiler Furnace Gas-MBH Other-MBH Oil Burner-Light Oils Gas-Pool Hot Tub Heater Furnace Oil-MBH Other-KW Range Hood Gas-Stove/Range/Wok Heat Pump-Tons Prefab Flue New Solar Heat Gas-Regulator Heat Pump-Tons Prefab Flue Replace Tank-Gasoline Gas-Space Heater Heat Pump Aux-MBH Prefab Fireplace Vent Smoke Pipe Gas-Water Heater Unit Heater Electric-KW Tank Fuel Oil Wood Stove Gas-Relocate Meter Unit Heater Gas-MBH Tank Propane Gas-Broiler Gas-Other Unit Heater Fuel-MBH Boiler Repair Gas-Dryer Other Commercial: New Replacement Contract Value $ Equipment Value $ QTY DESCRIPTION RATING QTY DESCRIPTION RATING QTY DESCRIPTION RATING QTY DESCRIPTION Ductwork: ☐ Yes ☐ No Refrigeration-Tons Unit Heater Oil-MBH Unfired Pressure Vessel Expansion Tank Unit Heater Gas-MBH Diffuser Wood Stove Indirect Water Heating Unit Heater Gas-MBH Exhaust Fan Boiler-Miniature Piping of Equipment Unit Heater Electric-KW Package HT/AC-KW Gas-Dryer Prefab Flue Replacement Unit Heater Electric-KW Variable Air Volume Gas-Grill Prefab Fireplace Boiler Hot Water Heat-MBH Other-Tons Gas-Log Pump Water Circulating Boiler Hot Water Heat-MBH Other-MBH Gas-Log Lighter Vent Smoke Pipe Boiler Hot Water Supply-MBH Other-KW Gas-Oven/Broiler Range Hood Fire Protection Boiler Hot Water Supply-MBH Air Compress Rec Tank Gas-Pool/Hot Tub Heater Range Hood Only Furnace Duct-MBH Air Handler Gas-Range/Stove/Wok Air Conditioner-Tons Boiler Power-HP Boiler Repair Gas-Regulator Air Conditioner-Tons Boiler Power-HP Hot Water Storage Tank Gas-Space Heater Furnace Electric-KW Boiler Steam-MBH Tankless Water Heater Gas-Water Heater Furnace Electric-KW Boiler Steam-MBH Hydronic Piping Gas-Relocate Meter Furnace Gas-MBH Chiller-Tons Incremental Heating AC Gas-Other Furnace Gas-MBH Chiller-Tons Oil Burner Heavy Oils Gas-Other Heat Pump-Tons Furnace Oil-MBH Oil Burner Light Oils Gas-Other Heat Pump-Tons Furnace Oil-MBH Paint Booth Exhaust Other Heat Pump Aux Heat-MBH Furnace Solid Fuel-MBH Solar Heat Other Heat Pump Aux Heat-MBH Incinerator-LBS/HR Steam Blowdown Tank Other Electrical Residential: New Replacement QTY DESCRIPTION RATING QTY DESCRIPTION RATING QTY DESCRIPTION RATING QTY DESCRIPTION RATING New Residential Service Baseboard Heat Transformer-KVA Dryer Service Unit Heater Fan Coil Unit Humidifier Temporary/Permanent Attic Fan Furnace–Electric UPS System-KVA Temporary/Construction Ceiling Fan Furnace–Gas/Oil Water Heater Sub Panel Central Vacuum Heating Equipment Oven Sub Meter Generator-KW Heat Pump Range Circuits Hot Tub Pump-HP Compactor Smoke Detector Fixtures Hydro Tub Pump-HP Cooktop Other-MBH Air Cleaner Motor-HP Dishwasher Other-KW Air Conditioner Sump Pump–HP Disposal Other Commercial: New Replacement QTY DESCRIPTION RATING QTY DESCRIPTION RATING QTY DESCRIPTION RATING QTY DESCRIPTION RATING Circuits Motor-HP Furnace Gas/Oil-KW Water Heater-KW Fixtures Transformer-KVA Heat Pump-KW Other-KW Service Transformer-KVA Heating Equipment-KW Other-KW Service UPS System-KVA Air Cleaner Carnival/Fair/Circus Temp/Construct UPS System-KVA Fan Coil Unit Central Vacuum Temp/Construct Compactor-HP Humidifier Dental Chair Temp/Permanent Dishwasher-HP Unit Heater Exterior Light Poles Temp/Permanent Disposal-HP Cooktop Gasoline Dispenser Sub Panel/Sub Meter Oven-KW Hot Tub Pump-HP Sign Fluorescent, #Tubes Sub Panel/Sub Meter Range-KW Hydro Tub Pump-HP Sign-Incandescent Low Voltage Fire Alarm Air Conditioner-HP Sump Pump-HP Sign-Neon Transformers Low Voltage Security Air Conditioner-HP Other Pump-HP Smoke Detector Low Voltage Voice/Data Air Handler-HP Compressor-HP Temp Wiring-Tents Stands Low
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