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PERMITTEE REGISTRATION APPLICATION

Rev. 10/6/15 LEGAL 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 #*:(_____)_____-_____(_____)_____-_____ Tel #*:(_____)_____-_____(_____)_____-_____P age 1 of 3 24-Hour Emergency Telephone Number* (Must be able to make immediate contact):____

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 License (Must attach a copy of the license). If the applicant name being registered is NOT the same as above, you will not be issued any water/sewer permits by NYCDOT.

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  Applications, Name, Registration, Permittee, Permittee registration application

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