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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. 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.

  3. 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 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.

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