SEWER PERMIT APPLICATION

SITE AND PROJECT DATA

Check which is applicable:

Residential

Commercial

Irrigation

Check which is applicable:

Inside City Limits

Outside City Limits

Description of Work:

Parcel Number

Lot Number:

Plat/Development:

Property Size

No. of Bldgs. on Site:

Property Owner's Phone Number

Property Owner's Email Address

The applicant name and address shall be used for future utility bills.

Is the Applicant someone other than the property owner?

Yes

Applicant Phone Number

Applicant Email

Is there a separate contact for this project?

Yes

Project Contact Phone Number:

Project Contact Email:

All inspection results shall be emailed to:

Contractor Name:

Contractor Phone Number

Contractor Email

UBI #

Contractor Lic #

CONNECTION DATA

Type of Service:

No. of Dwelling Units:

No. of Commercial Units:

Type of Sewer Pipe:

Pipe Size:

Check which is applicable:

Grease Interceptor

Grease Trap

Tenant Improvement

Lender/Issuer of Payment Bond:

Lender/Issuer Phone Number

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

All sewer lines to be tested full length and approved prior to building connection. Existing septic tank(s) shall be pumped and filled with inert material. Approved piping materials: Ductile Iron, ABS (SCH40), P.V.C. (SDR-35). I agree to comply with all City ordinances and design standards, State laws and lawful orders of the inspector. I further agree to reimburse the City for any charges incurred from outside agencies (State, County, etc.) I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. Any changes will be reported to the jurisdiction in which the permit is valid immediately. By leaving the contractor information section blank, I hereby certify further that contractors (general or subcontractors) will not be hired to perform any work in association with this permit. I also certify that if I do choose to hire a contractor (general or subcontractor) I will only hire those contractors that are licensed by the State of Washington.

Signer:

Owner

Agent

Contractor