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PERMITTEE REGISTRATION APPLICATION

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Rev. 10/6/15LEGAL ENTITY TYPE: (CHECK ONLY ONE)Page 1 of 3____ CORPORATION, LLC OR LLP (COMPLETE SECTIONS 1A, 2 TO 5)____ PARTNERSHIP (COMPLETE SECTIONS 1B, 2 TO 5)_____ JOINT VENTURE (COMPLETE SECTIONS 1C, 2 TO 5) ____ SOLE PROPRIETORSHIP (COMPLETE SECTIONS 1D, 2 TO 5)Field with an asterisk (*) next to it is mandatory. NYS Department of State Number*:________________________________ ________________________________________ ____ Tel #*:(__________)____________-____________ ____(__________)______________-_________ _____ NY State Department of State (NYS DOS) Additional Information NYS DOS Process Address: (Address to which DOS will mail process if accepted on behalf of the entity) Index Number (Provided by County Clerk Office):________________________________ ___________________________________ Tel #*:(__________)____________-____________ ____(__________)______________-_________ _____ Tel #*:(__________)____________-____________ _

NOTE: E-mail address is required if applicant wishes to use the on-line NYCStreets Permit Management System. NOTE: NYCDOT will only issue permits in the name of the licensed plumber or the applicant name as shown on the Department of Buildings Plumbers

  Applications, Registration, Permittee, Permittee registration application

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