This leak adjustment request must be filled out by the owner of the property. If you are a tenant, please contact the owner and ask them to fill out this form.
Please click on the above link to read City Resolution no. 655, which establishes a one-time water leak adjustment policy.
I have read and understand City Resolution no. 655.
I certify that I have notified the city of the leak within a one month period of the discovery of the leak.
I certify that the leak on the service address listed below was repaired within ten (10) days of notification or discovery of leak.
I certify that I am the property owner.
I understand that I must provide supporting documentation that the leak was fixed. If I do not provide documentation, I may not receive the leak adjustment.
Please attach any supporting documents and/or receipts that verify your leak has been repaired. If you cannot scan and upload them, please send to Tami Wood:
Mail: PO Box 987; Snoqualmie 98065;
In Person at City Hall: 38624 SE River St; Snoqualmie 98065
Please explain how you have or will be submitting your supporting documents that the leak was fixed.
I am the owner of the above named property and the leak on the service address was repaired within ten (10) days of notification of leak. I have read and understand City Resolution no. 655 and certify that all the information contained herein is accurate, to the best of my knowledge.
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