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City of Puyallup I Engineering Services 333 S Meridian I Puyallup I WA 98371 Tel: (253) 841-5568 I Fax: (253) 840-6678 Rev:7/16 www.cityofpuyallup.org CERTIFICATION: I certify that I have read this application and declare under penalty of perjury that the information contained herein is correct and complete. I am either the owner of the property described or I represent the owner as signified above and am acting with the owner’s full knowledge and consent. Signature of Applicant: Date City of Puyallup I Engineering Services UTILITY CONNECTION APPLICATION APPLICANT Name: Address: City St Zip: Contact No: Email: OWNER Name: Address: City St Zip: Contact No: Email: CONTRACTOR Name: Address: City St Zip: Contact No: Email: WA STATE CONTRACTOR INFO WA State License No: Exp Date: City Business License No: SITE ADDRESS: PARCEL NO: ZONING: Provide a site plan showing location of proposed work SCOPE OF WORK - SEWER: Residential Commercial *NEW Connection Repair Pipe Size/Type No. of Cleanouts New Line L.F. Tap on main required? *Yes No Septic Tank Decommissioning (PCHD Application required) *NEW CONNECTIONS REQUIRE A TAP ON THE MAIN – AN ADDITIONAL R-O-W PERMIT IS REQUIRED. SCOPE OF WORK – WATER: Residential Commercial *NEW Connection Repair Irrigation Meter Size New Line L.F. RPBA DCVA DDCVA Well Decommissioning (PCHD Application required) *NEW CONNECTIONS REQUIRE A TAP ON THE MAIN – AN ADDITIONAL R-O-W PERMIT IS REQUIRED. ---PAGE BREAK--- City of Puyallup I Engineering Services 333 S Meridian I Puyallup I WA 98371 Tel: (253) 841-5568 I Fax: (253) 840-6678 Rev:7/16 www.cityofpuyallup.org CHECKLIST FOR UTILITY PERMIT APPLICATION In order to review an application for a utility permit, Engineering Services requires the following information: ❏ 1 completed Application Form – signed and dated. ❏ Site plan showing location of proposed work. Sanitary Sewer plan review, permit and inspection fees: ❏ Commercial/Multi-Family new connection Contact Engineering Services ❏ Residential on-site repair $160.00 ❏ Residential new connection - stub connection $356.00 + (SDC) ❏ Residential new connection - tap main* $636.00 + (SDC) Contact Engineering Services for current SDC fee information *NEW CONNECTIONS THAT INVOLVE WORK IN THE RIGHT-OF-WAY MUST BE COMPLETED BY A LICENSED AND BONDED CONTRACTOR. Water Service plan review, permit and inspection fees: ❏ Commercial /Multi-Family connection Contact Engineering Services ❏ Residential on-site repair $130.00 ❏ Residential new connection – 5/8” meter set only $500.00 + (SDC) ❏ Residential new connection – main tap & meter set $2,638.00 + (SDC) Contact Engineering Services for current SDC fee information Water turn-on must be paid for and coordinated directly with the Utility Billing Division located on the 3rd floor of City Hall or by phone (253) 841-5550.