Mobile Commercial Cosmetic Cleaning (Power Washing) Permit Application

Mobile Commercial Cosmetic Cleaning

(Power Washing) Permit Application

$25 for Cosmetic Cleaner Application $25 per Individual Wash Unit

Is this a renewal?*

Select

Current Permit Number*

Company Name*

Owner First Name*

Owner Last Name*

Owner Street Address*

Street Number and Name Only

Address may be different than company address

City, State, & Zip Code*

Owner Phone Number*

Phone

Owner Email Address*

Is the company contact information different than the owner information?*

Yes

No

Company Contact Name*

Company Contact Phone Number*

Phone

Other Contact Email Address*

Company Address

Is the owner address different than the mailing address?*

Yes

No

Mailing Address*

No. Employees

Total No. Washer Units*

Are the washers on a vehicle or trailer?*

Vehicle

Trailer

Both

Number of Vehicles*

Select

License Number of vehicle containing washer unit*

How many washers do you have on this vehicle?*

License Number of second vehicle containing washer unit*

How many washers do you have on this vehicle?*

License Number of third vehicle containing washer unit*

If more than three units, other license numbers can be listed in the multiple licenses section of the application. Please include number of washers with each license number.

How many washers do you have on this vehicle?*

Number of Trailers*

Select

License number of trailer containing washer unit*

How many washers are on this trailer?*

License number of second trailer containing washer unit*

How many washers are on this trailer?*

License number of third trailer containing washer unit*

If more than three units, other license numbers can be listed in the multiple licenses section of the application. Please include number of washers with each license number.

How many washers are on this trailer?*

Multiple Licenses*

Add multiple licenses for vehicles and trailers here. Please indicate how any washers are on each vehicle/trailer after the license plate number. Ex. 1234ABC-2; 4321FGH-3; etc.

Is a recycle unit used*

Yes

No

If Yes, what type of recycle unit is being used?*

Select or enter value

Are you discharging to the sewer system?*

Yes

No

Zip Code of Discharge Point

Address of Discharge Point

Please do not include City, State. Only fill in the address.

Address of additional discharge points

Zip Code of additional discharge points

Type of Discharge

Select

Required documentation for permit application:*

Upload a copy of driver's license for all operators, proof of insurance for vehicle(s) and proof of insurance for trailer(s)

Drag and drop files here or

Do you have any questions or comments?

If applies, please add additional license for vehicles and trailers in this section.

Send me a copy of my responses

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