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2. Temporary Construction Water Meter Application
6. Site Address:*
   Cross roads if no know address
8. Hydrant Number:
10. Purpose of Rental:*
    Please provide information that may be important
12. Applicant's Full Name/Business Name:*
13. Applicant's Contact Phone:*
15. Billing Address:*
17. Email address:
    Please provide an email address as we will be sending receipt of payment and any correspondence
19. I understand that a deposit must be made before this application can be processed*

    1. I understand and accept the charges.

    *We will be contacting you to receipt in payment before we hook up the meter*
23. Installation Process:
    The installation of your meter will usually take a few days from the time of your meter purchase
24. Hook Up Charge:

    $65.23 Includes meter, back flow rentals, testing, and first 1,000cf of use

26. Usage Rate:

    $4.23 per 100cf of water after first 1000cf

    
    

27. Maximum Usage:
    60 Days
29. Important Information - Please Read
    Applicant is responsible for loss or damage to meter or back flow equipment which includes freeze damage. The City does not provide a pressure reducing valve. To discontinue service, contact the City Shop at 360.293.1921. Temporary water use is the first service to be disconnected in the event of an emergency water shortage.
31. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
33. Electronic Signature*
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field