1 COMMUNITY DEVELOPMENT DEPARTMENT Code Administration Division 129 North Second Street, 2nd Floor Yakima, Washington (509) Fax (509) COMMERCIAL BUSINESS LICENSE APPLICATION COMPLIANCE WITH THE URBAN AREA ZONING ORDINANCE IS REQUIRED PRIOR TO ISSUANCE OF ANY/ALL BUSINESS LICENSES **ALL INCOMPLETE APPLICATIONS WILL BE RETURNED** GENERAL BUSINESS INFORMATION Business Name: Physical Location: Suite Parcel Number: Zoning: Mailing Address: Suite # Attention: City: State: Zip: Business Phone: FAX #: WA State UBI#: (Tax Number) Parent Company Name (if applicable): Address: Ownership Type: Individual Partnership Association Corporation LLC Is this business a change in ownership of an existing business? Detailed Description of Business: Previous Location and License Number: OWNERS/OFFICERS List Owners/Officers Below: (Use Separate Page if Needed) Business License Number BL-0 Name: Home Address: City, State, Zip: Name: Home Address: City, State, Zip: Title: Phone: Title: Phone:
2 OPERATION INFORMATION Hours of Operation: Days of Operation: Number of Employees and Owners Combined: Tax Exempt? Y/N Will there be alterations to the building for your business? Y/N Does this business share space with other business(es)? Y/N If Yes, please provide name of business(es): REQUIRED ATTACHMENTS The following attachments are required in the following situations: change to a use requiring more parking per code; change in site layout (i.e. revised parking, circulation, building layout; relocation or addition of utility lines/appurtenances); adding an additional business in an existing building. (Please contact City staff if you have questions on applicability.) a. A scaled site plan including the location of off-street parking as well as onsite water and sewer infrastructure. Also include the location and number of disabled parking spaces and whether the lot is paved or unpaved. A current aerial photo may substitute the site plan requirement if the existing parking configuration can be deciphered from the aerial and if the new use does not change the required number of parking spaces or utility layout. b. A scaled floor plan which identifies the use of each room in the building. c. A complete application for Type 1, 2, or 3, depending on zoning designation. d. A completed IW Survey Form (attached) or indicate the date when the electronic IW Survey form was submitted: ACCESSIBILITY Please be advised that changes in occupancy of an existing building often trigger accessibility requirements such as accessible parking spaces, an accessible building entrance, and other items. Improvements that require permits may also trigger accessibility requirements in an existing building. The issuance of this license is a tax on your business activity and does not entitle you to conduct business in violation of any other federal, state or local laws applicable to that business operation. Applicant is responsible for obtaining approval from property owner for all activities conducted on private property. Applicant's Signature and Title Printed Name Date # Owners/ Employees over 80 Fee $42.90 $85.80 $ $ $ $ $ $ $1, $1, Those applying after June 30 th will be charged half price.
3 FOR OFFICE USE ONLY Prev Occu Class: NEW Occu Class: Change of Use: Y/N Tax Exempt: Y/N No Yes Fire, Life, Safety Inspection Prior to Issuing License ( ) ( ) Change of Occupancy ( ) ( ) Fire, Life, Safety Inspection Prior to Opening ( ) ( ) Building Inspection Required (restrooms, parking, etc.) ( ) ( ) Reviewed by Planning Staff: Date: Zoning: CL(1) CL(2) CL(3) Use label in Table 4-1 of UAZO Parking spaces for this use: Required Provided Comments: Reviewed by Code Admin Staff: Date: Comments:
4 INDUSTRIAL WASTE SURVEY YAKIMA REGIONAL WASTEWATER DIVISION Wastewater Generating Characteristics and Chemical Usage Wastewater Information Please complete this survey in full for each wastewater account serving your business. Type or print clearly with ink or, to fill out the form online, visit the City of Yakima website at: Where the required answer is contained in brackets, circle the answer so it remains legible. A Federal and State requirement has been placed on this community to accomplish this inventory. Failure to submit a completed survey will be in violation of Chapter 7.65 of the City s Municipal Code. Please request assistance if completing this survey cannot be performed within thirty (30) days. You may contact the Pretreatment Supervisor at (509) Company Name: 2. Business License Number: 3. Billing Account Number: 4. Division Name: 5. Address of facility discharging wastewater: Street City State WA Zip Parcel Number(s) 6. Mailing address for correspondence purposes: Street (or PO Box) City State WA Zip 7. Representative completing this form: Name: Title: Telephone No. ( ) 8. North American Industry Classification System Code (NAICS Code) (you may obtain this code by visiting 9. Please provide a brief description of your business type and general activities, sales & services you provide.
5 10. Please describe the process that will result or may result in wastewater discharge to the domestic or industrial sewer system. 11. This facility generates or will generate the following types of wastes. (Circle all that apply) Waste Category Gallons Per Day Est or Meas.  Domestic Wastes (*) [E] [M]  Cooling Water, Noncontact [E] [M]  Boiler/Tower Blowdown [E] [M]  Cooling Water, Contact [E] [M]  Process Waste [E] [M]  Equipment/Facility Washdown Water [E] [M]  Air Pollution Control Unit Waste [E] [M]  Storm Water Runoff to Sewer [E] [M]  Other [E] [M] * (restrooms, employee showers, etc. EPA suggests 15 Gals per day for each employee for domestic waste) 12. Is the waste discharge Continuous [C] or Batch [B]? 13. Wastes are discharged or may be discharged to: (Circle all that apply) Waste Category Gallons Per Day Est or Meas.  Domestic Sewer [E] [M]  Storm Sewer [E] [M]  Surface Water [E] [M]  Ground Water (on-site disposal) [E] [M]  Waste Haulers [E] [M]  Other [E] [M] If Waste Hauler is indicated, please provide name and address of waste hauler(s): 14. List all principle materials regularly used in your facility that may be present in your wastewater discharge (such as cleaning agents, solvents, food processing wastes, plating solutions, catalysts, milk wastes, ink, pesticides, etc.). Identify chemical constituents (if known) and brand name. Attach Material Safety Data Sheets (MSDS) for each material listed. Amount Chemical Constituents Generic Type Per Year or Brand Name a. Example: Degreaser 3 gallons Trichlorethylene b. c. d. e. f.
6 g. If additional sheets are attached, please circle [A] 15. Characteristics of Wastewater: a. Temperature ( F) Don t Know [D] b. ph level Don t Know [D] c. Flammable or explosive materials Yes [Y] No [N] Don t Know [D] d. Solid or viscous materials Yes [Y] No [N] Don t Know [D] c. Priority pollutants Yes [Y] No [N] Don t Know [D] 16. If your facility employs processes in any of the industrial categories or business activities listed below and any of these processes generate or cogenerate wastewater or waste sludge, circle the number beside the category or business activity. (Circle all that apply) Industrial Categories:  Adhesives  Metal finishing  Aluminum forming  Nonferrous metals  Auto and other laundries  Ore mining  Bakery  Organic chemicals  Battery manufacturing or recycling  packaging/rendering  Beverage bottler  Paint and ink  Can Making  Pesticides  Catering  Petroleum refining  Coal Mining  Pharmaceuticals  Coil Coating  Photographic supplies  Copper forming  Plastic and synthetic materials  Dairy products  Plastics processing  Electric and Electronic Components  Porcelain enamel  Electroplating  Printing and publishing  Explosives manufacturing  Pulp, paper, and fiberboard  Food/edible products processor  Rubber  Foundries  Restaurant/Bar/Fast Food  Gum and wood chemicals  Slaughter/meat  Gum and wood chemicals  Soaps and detergents  Inorganic chemicals  Steam electric  Iron and steel  Textile mills  Leather tanning and finishing  Timber products  Mechanical products  Waste recycler  Other: 17. If your facility uses any pretreatment devices or processes listed below for treating wastewater or sludge, circle the number beside the device or process. (Circle all that apply)  Air flotation  Sedimentation  Centrifuge  Septic tank  Chemical precipitation  Solvent separation  Chlorination  Spill protection  Cyclone  Sump  Filtration  Biological treatment,  Flow equalization type  Grease or oil separation,  Rainwater diversion or storage type
7  Grease trap  Other chemical treatment,  Grinding filter type  Grit Removal  Other physical treatment  Ion exchange type  Neutralization, ph correction  Other,  Ozonation type  Reverse osmosis  No pretreatment provided  Screen 18. Are any liquid wastes or sludges from this firm disposed by means other than discharge to the sanitary sewer system Yes [Y] No [N] If Yes, indicate the type of waste, amounts, and storage/disposal methods. (Circle all that apply) Waste Type Amount Per Year Gallons or Pounds  Acids and alkali [G] or [P]  Heavy metal sludges [G] or [P]  Inks/dyes [G] or [P]  Oil and/or grease [G] or [P]  Organic compounds [G] or [P]  Paints [G] or [P]  Pesticides [G] or [P]  Plating wastes [G] or [P]  Pretreatment sludges [G] or [P]  Solvents / Thinners [G] or [P] Other hazardous wastes (specify) Amount Per Year Gallons or Pounds  [G] or [P]  [G] or [P]  [G] or [P]  [G] or [P] For the above checked wastes, does your company practice (circle all that apply):  On site storage  Off site storage  On site disposal  Off site disposal Briefly describe the method(s) of storage or disposal indicated above. 19. Has any wastewater analysis been performed on the wastewater discharge(s) from your facility within the recent past? Yes [Y] No [N]
8 If Yes, attach a copy of the most recent data to this questionnaire. Be sure to include the date of the analysis, name of the laboratory that performed the analysis, and the location(s) from which the sample(s) were taken. Attach sketches, plans, etc. as necessary. 20. Are any process changes or expansions planned during the next three (3) years? Yes [Y] No [N] If Yes, attach a separate sheet to this questionnaire describing the nature of planned changes or expansions. 21. Attach a simple schematic drawing of your facility, indicating: a. Location and size of all service outlets, process drains, and floor drains. b. Existing sampling manholes or locations where samples may be collected. c. Current or planned flow metering equipment. d. Current or planned automatic sampling equipment. e. Location of pretreatment processes, treated flows, and untreated flows. f. Location and names of pertinent streets. g. Use flow schematic to indicate process and process discharge gpd. 22. Comments: Thank you for your cooperation. The information provided in this survey is, to the best of my knowledge, true and complete. Signature Date Please print name Title Please send completed form within 30 days to: Pretreatment Office Yakima Regional Wastewater Division 2220 E. Viola Ave. Yakima, WA 98901