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2. Service Address*
4. Primary Account Holder:
6. First Name*
7. Last Name*
9. New Mailing Address *
11. City*
12. State*
13. Zip*
15. Effective Date *
    Effective Date
17. Primary Phone Number*
19. Email Address
21. 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.

     

     

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23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

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