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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:10/13 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:10/13 www.cityofpuyallup.org CHECKLIST FOR UTILITY PERMIT APPLICATION In order to review an application for a utility permit, the City of Puyallup 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: on-site repair residential/commercial $160.00 Residential new connection - stub connection $356.00 + $4,520.00(SDC’s) *Residential new connection - tap main $466.00 + $4,520.00(SDC’s) Commercial/Multi-Family new connection Contact Engineering Services * additional Right-of-Way permit $170.00 *NEW CONNECTIONS/REPAIRS THAT INVOLVE WORK IN THE RIGHT-OF-WAY – AN ADDITIONAL R-O-W PERMIT IS REQUIRED BY A LICENSED AND BONDED CONTRACTOR. Water Service plan review, permit and inspection fees: on-site repair residential/commercial $130.00 Residential new connection – meter set only $500.00 + $3,130.00(SDC’s) *Residential new connection – main tap & meter set $2,638.00 + $3,130.00(SDC’s) Commercial /Multi-Family connection Contact Engineering Services * additional Right-of-Way permit $170.00 Water turn-on must be paid for and coordinated directly with the City of Puyallup’s Utility Billing Division located on the 3rd floor of City Hall or by phone (253) 841-5550 *NEW CONNECTIONS/REPAIRS THAT INVOLVE WORK IN THE RIGHT-OF-WAY – AN ADDITIONAL R-O-W PERMIT IS REQUIRED BY A LICENSED AND BONDED CONTRACTOR.