Skip to Main Content
Government
Departments
Community
Smart Growth
Services
Home
Forms Center
Forms Center
Search Forms:
Search Forms
Select a Category
All Categories
Building Division
Comprehensive Plan Docket Form
Concerns & Questions
Fire Department
Meeting Room Requests
Parks
Police Department
Public Records Requests
Public Works
Utility Billing
Volunteering
By
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Sign in to Save Progress
Leak Adjustment Request
This form has been modified since it was saved. Please review all fields before submitting.
Steps
1.
Step One
This section is complete
This section is incomplete
2.
Step Two
This section is complete
This section is incomplete
Step One
Instructions
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.
Leak Adjustment Resolution
City Resolution no. 655
Please click on the above link to read City Resolution no. 655, which establishes a one-time water leak adjustment policy.
Resolution Verification
*
I have read and understand City Resolution no. 655.
Check Here
Notification of Leak
*
I certify that I have notified the city of the leak within a one month period of the discovery of the leak.
Check Here
Fixed Leak
*
I certify that the leak on the service address listed below was repaired within ten (10) days of notification or discovery of leak.
Check Here
Property Owner Verification
*
I certify that I am the property owner.
Check Here
Continue
Step Two
First Name
*
Last Name
*
Service Address
*
City
State
Zip Code
Phone Number
Account Number
Date you were notified or became aware of leak
*
Date you were notified or became aware of leak
Date leak was repaired
*
Date leak was repaired
Understanding of Supporting Documents
*
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.
Check Here
Supporting Documents Upload
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: Email: twood@ci.snoqualmie.wa.us; Mail: PO Box 987; Snoqualmie 98065; In Person at City Hall: 38624 SE River St; Snoqualmie 98065
Notes or explanation for Utility Billing Clerk
*
Please explain how you have or will be submitting your supporting documents that the leak was fixed.
Signature
*
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.
Please provide an email address for questions about your request:
*
If you have questions, please email Tami Wood: twood@snoqualmiewa.gov
Leave This Blank:
Receive an email copy of this form.
Email address
This field is not part of the form submission.
Submit
Submit and Print
|
Go Back
* indicates a required field
Arrow Left
Arrow Right
[]
Slideshow Left Arrow
Slideshow Right Arrow
