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2. I am requesting that my utility account be placed on the abandoned occupant rate. I understand that in order to receive this rate, my water service will be discontinued (shut off) for a minimum of 180 days and that a minimum monthly maintenance charge, as set forth by City Council for turned off services, will be charged. There is a $30 Voluntary Water Turn Off Fee per the fee schedule to perform this service that will be added to your account at time of turn off. This is in accordance with Section 8 of Ordinance 2498. Penalty for early termination includes charging base rate for unbilled services from the discontinued date to the restore date, if less than 180 days. This application will need to be renewed every 365 days. *
   I am requesting that my utility account be placed on the abandoned occupant rate. I understand that in order to receive this rate, my water service will be discontinued (shut off) for a minimum of 180 days and that a minimum monthly maintenance charge, as set forth by City Council for turned off services, will be charged. There is a $30 Voluntary Water Turn Off Fee per the fee schedule to perform this service that will be added to your account at time of turn off. This is in accordance with Section 8 of Ordinance 2498. Penalty for early termination includes charging base rate for unbilled services from the discontinued date to the restore date, if less than 180 days. This application will need to be renewed every 365 days. Start Date

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   I am requesting that my utility account be placed on the abandoned occupant rate. I understand that in order to receive this rate, my water service will be discontinued (shut off) for a minimum of 180 days and that a minimum monthly maintenance charge, as set forth by City Council for turned off services, will be charged. There is a $30 Voluntary Water Turn Off Fee per the fee schedule to perform this service that will be added to your account at time of turn off. This is in accordance with Section 8 of Ordinance 2498. Penalty for early termination includes charging base rate for unbilled services from the discontinued date to the restore date, if less than 180 days. This application will need to be renewed every 365 days. End Date
4. I understand that there will be no water service provided at this property and that the meter will be shut-off and locked.*
6. I certify that there is no Fire Sprinkler attached to the water meter.*
8. I understand that a minimum monthly maintenance charge as set forth by resolution of City Council for turned off services will be charged.*
10. I understand I will need to contact the City five days before I want water service reconnected.*
12. I understand that I must complete and submit this request prior to the account being placed on Abandoned Occupant Rate.*
14. I understand that the property must be unoccupied for a continuous period of 180 days and not to exceed 365 days without application renewal.
16. First Name*
17. Last Name*
19. Email Address:*
21. Service Address (98290 zip code only)*
23. Account Number
25. By submitting this application and entering my name below, I agree and acknowledge my electronic signature is valid and binding and contains the same force and effect as my handwritten signature. I acknowledge that the information submitted is true and correct and that I have authority to and I am authorized to submit and execute this application for Abandoned Occupant Utility Rates. By submitting this application for Abandoned Occupant Utility Rates, I acknowledge that the application for Abandoned Occupant Utility Rates is subject to suspension or revocation if false or misleading information is provided; and violation of any conditions and/or requirements of the Snohomish Municipal code or any permit conditions may result in the revocation of an Abandoned Occupant Utility Rates and the forfeiture of any fee paid.
27. First Name*
28. Last Name*
29. Date*
    Date
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31. 1. Receive an email copy of this form.
32. Email address

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33. Submit

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