Form Center

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.

Request for Adjustment Due to Water Leak

  1. You can print this form and submit to Snohomish City Hall with supporting documents or submit online and upload supporting documents.
  2. The credit for water and sewer charges is based (hundreds of cubic feet) from high billing period, minus overage consumption units from last year, an adjusted overage water rate of $2.45, and an adjusted sewer rate of $4.68 (for 5/8" meters inside City limits). A Sewer Winter Average may also be taken into account based on the time of year.
  3. I am the owner of the service address property and I am requesting that my bill be adjusted to a consumption level equal to the same billing period from the previous year. The attached copy of an invoice/receipt from a plumber or hardware store documents that the leak has been repaired. I understand I cannot receive another leak adjustment for this property for 24 months.
  4. 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, as the property owner, to and I am authorized to submit and execute this application for an Adjustment Due to a Water Leak. By submitting this application for an Adjustment Due to a Water Leak, I acknowledge that the application for an Adjustment Due to a Water Leak 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 Adjustment Due to a Water Leak and the forfeiture of any fee paid.
  5. Leave This Blank:

  6. This field is not part of the form submission.