Utilities Permit Application - City Of Auburn - 2016
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1
2WATER/SEWER/STORM/BACKFLOW
Updated
UTILITY PERMIT
June 2016
APPLICATION
Physical Address:
Mailing Address:
Webpage & Email:
Phone & Fax:
nd
Auburn City Hall Annex, 2
Floor
25 West Main Street
Phone: 253-931-3090
1 East Main Street
Auburn, WA 98001-4998
permitcenter@auburnwa.gov
Fax: 253-804-3114
PROJECT INFORMATION
Check all that apply: Water
Sewer
Stormwater
Backflow
Permit Numbers
Single Family Residence Commercial Duplex Multifamily: # of units______
WTR_______ - _________
Job site address:_________________________________ Zip:_________ Lot #:___
Tenant Name:_______________________________ Parcel #:_________________
SWR_______ - _________
Complex Name:______________________________ Building #:_____Suite #:____
For Condominiums – Building Name:____________________________ Unit #:____
STM _______ - _________
For Mobile/Manufactured Homes – Park Name:___________________ Space #:___
BFL_______ - _________
SCOPE OF WORK
: _________________________________________________
___________________________________________________________________
Parent Permit #
___________________________________________________________________
___________________________________________________________________
Owner
Contractor
Other______________________________________________
APPLICANT
Name:______________________________ Phone #:___________________ Email:_________________________
OWNER
CONTRACTOR
Name:_______________________________________
Company Name: ________________________________
Check this box if this is the primary contact
Check this box if this is the primary contact
Contact Person:_______________________________
Contact Person:_________________________________
Address:_____________________________________
Address:_______________________________________
City:___________________ State:____ Zip:________
City:___________________State:____ Zip:___________
Phone:______________________Fax:_____________
Phone:_________________ E-mail:_________________
E-mail: ______________________________________
Auburn Business Lic#:_________ WA UBI#:___________
STORM APPLICATION
CIRCLE ONE: New Development
Modification to Existing Development
Grading Related
Total New Impervious Surface (sq ft):__________________ Total Area to be Disturbed (sq ft):_________________
Description of work:___________________________________________________________________________
SEWER APPLICATION
CIRCLE ONE:
New Connection
Side Sewer Repair
Demo Capping
Tenant Improvement
No
Yes If so,
IS ANY WORK WITHIN THE PUBLIC ROW
Construction Permit
required
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