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2. I am requesting that my utility account be placed on the abandoned rate. I understand that in order to receive this rate, my water service will be discontinued (shut-off) and that my property can not have any water consumption during the time period below:*
   I am requesting that my utility account be placed on the abandoned rate. I understand that in order to receive this rate, my water service will be discontinued (shut-off) and that my property can not have any water consumption during the time period below: Start Date

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   I am requesting that my utility account be placed on the abandoned rate. I understand that in order to receive this rate, my water service will be discontinued (shut-off) and that my property can not have any water consumption during the time period below: 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. First Name*
15. Last Name*
17. Email Address:*
19. Service Address (98290 zip code only)*
21. Account Number
23. 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.
25. First Name*
26. Last Name*
27. Date*
    Date
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29. 1. Receive an email copy of this form.
30. Email address

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31. Submit

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