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2. PLEASE NOTE: Accounts that are turned off or snowbirded off will continue to accrue a late payment fee and/or a collection fee each month if the monthly statement is not paid in a timely manner. 

   TOME NOTA: Las cuentas que estén desconectadas o suspendidas por el invierno seguirán acumulando un cargo por pago atrasado y/o un cargo de colección cada mes si el estado de cuenta mensual no se paga a su debido tiempo. 

4. Request Type: *
   -- Select One --Snowbird Off Temp Off
6. Effective date?
   Effective date?
8. Full Legal First Name: *
9. Middle Name or Initial:
10. Full Legal Last Name:*
12. Service Address:*
14. Mailing Address (if different than Service Address):
16. City
17. State
18. Zip
20. Primary Phone Number: *
21. Secondary Phone Number:
23. Email Address:
25. PLEASE NOTE

    Your e-mail and any e-mail responses from the City are considered a public record and will be subject to disclosure under Washington’s Public Records Disclosure Act.

Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field