HomeMy WebLinkAboutPC-Utility_Permit-AppCITY OF ? Public Works Division For Staff Use Only
T A BURN 25 West Main Street Application No:
V Auburn, WA 98001
WAS IIINGTONI (253) 931-3010
Utility Permit Application
Permit Type (circle): Residential Commercial
Project Information:
Site Address:
Parcel No. or Legal Description: (required)
Property Owner: Address: Phone No.:
Project Applicant: Phone No.: Email:
Contractor: Phone No.:
Address:
State Contractors License # : Auburn Business License #:
Existing Meter Box? (Circle) Water Application
Yes or No
No of Units: Domestic Meter Size: Deduct Meter Size: Irrigation only Meter Size:
Type of Use (Circle) Sewer Application
New Connection Repair
Demo Capping Tenant Improvement
Type of Use (Circle) Storm Application
New Construction Repair
Grading Only
Description of Work:
(FOR OFFICE USE ONLY)
Domestic Water Meter Permit Fee: County Inspection Fee: Fire line Connection Fee:
Deduct Water Meter Permit
Fee: Irrigation Water Meter
Permit Fee: Domestic SDC : Irrigation Only Meter SDC:
Assessment OFF*$) Paybacks: Total Water Fees:
Sewer Permit Fee: SDC ( RCE * $850): County Inspection Fee:
Assessment ( FF*$ ) Paybacks: Total Sewer Fees:
Storm Permit Fee: SDC:
Assessment ( FF*$ ) Paybacks: Total Storm Fees:
Application Reviewed By:
Date: Ok to
Issue:
I certify the information furnished by me is true and correct and that I am the owner of the subject property or I have been
given express permission by the owner of the subject property, to submit this application for permit. I will comply with all
provisions of law, code and ordinances governing this type of construction work, including state contractor registration
laws.
Application expires 180 days after Date Submitted
Owner/Agent Date
C: Documents and Settings tjotmso`Desktop `UTILITY PERMIT APPLICaTION.DOC 2 282007