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2. Request Type: *
   -- Select One --Snowbird OnTemp On
4. Effective date?
   Effective date?
6. Full Legal First Name: *
7. Middle Name or Initial:
8. Full Legal Last Name:*
10. Service Address:*
12. Mailing Address (if different than Service Address):
14. City*
15. State*
16. Zip*
18. Primary Phone Number: *
19. Secondary Phone Number:
21. Email Address:
23. 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:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

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