Form Txl 184 - Application For Certificate Of Registration And Licensing - City Of Taxoma, Washington Page 3
ADVERTISEMENT
1
2
33. Do you or will you maintain any of the following?
Stormwater
Wastewater
Last date serviced
Grease intercepter/trap
___________________
❐
Oil-water separator
___________________
❐
❐
Other ______________________________________
___________________
❐
❐
Storm water pond
___________________
❐
❐
Bioswale
___________________
❐
Infiltration
___________________
❐
Storm water vault
___________________
❐
Cartridge Filtration Unit
___________________
❐
Rain garden, pervious pavement,
___________________
❐
other low impact storm water mgmt
Other ______________________________________
___________________
❐
4. Are any of the following present at the facility?
❐ Oil storage tanks, containers or drums
❐ Chemical storage tanks, containers or drums
❐ Diesel or gasoline tanks or drums
❐ New or used antifreeze tanks, containers or drums
5. Does this facility have a Spill Containment or Countermeasure Plan? ❐ Yes ❐ No
Do you own real estate that you rent or lease inside Tacoma? Yes ❐ No ❐
If yes, you must also complete the rental address information below for each property. If you have more than two rental properties in the
City of Tacoma, please attach additional information.
Rental Address (within city limits)
Address __________________________________________________________________________
# of units __________ Parcel # __________
__________________________________________________________________________
Dwelling Type: ❐ Commercial ❐ Single Family ❐ Multi Family
Monthly Rental Income: $ _______________
Local Agent: ______________________________________________________________________
Phone No. ____________________________
On Site Agent: ❐ Yes ❐ No
Phone No. ____________________________
Rental Address (within city limits)
Address __________________________________________________________________________
# of units __________ Parcel # __________
__________________________________________________________________________
Dwelling Type: ❐ Commercial ❐ Single Family ❐ Multi Family
Monthly Rental Income: $ _______________
Local Agent: ______________________________________________________________________
Phone No. ____________________________
On Site Agent: ❐ Yes ❐ No
Phone No. ____________________________
The undersigned hereby certifies that the information shown is correct to the best of his/her knowledge and belief under
penalties of perjury. The undersigned acknowledges that this business is governed by the Tacoma Municipal Code and is responsible
for becoming familiar with the code and abiding by its requirements.
______________________________________________ _________________________________________________________________
Signed by
(Signiture of preparer if other than owner, partner or officer)
(Owner, partner or officer)
Title ________________________________________
_______________________________________________________________________
________________
(Preparer address)
(Date)
Please see Payment and Mailing Instructions on Page 4
OFFICE USE ONLY TYPE OF ID:
WDL
WID
MIL
MAIL
OTHER_________________________ ID# _______________________________
❐
❐
❐
❐
❐
NAICS _____________ Classes______ ______ ______ ______ ______ NR
M
Q
A
❐
❐
❐
❐
ABLs Year & Amt. Paid ____________________________________________
Forms Sent _______________________________________________________
Taxes Paid ______________________________________________________
Licenses ________________________________________________________
System Entry _____________________________________________________
(Date & Initial)
Page 3
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Hsmv 82040 - Application For Certificate Of Title With/without Registration/form Hsmv 82050 - Notice Of Sale And/or Bill Of Sale For A Motor Vehicle,mobile Home, Off-highway Vehicle Or Vessel
Legal
Form Alc 117 - Application For Certificate Of Registration For Manufacturers Of Alcoholic Beverages And High Alcohol Content Beer
Financial
Related Categories
Parent category: Financial