HYDRANT FLOW METER APPLICATION 2019
Register Receipt #: Bars Code: 0750 / 401.237.104
Pr
oject Number: Project Name:
Project Address:
Hydrant Location:
APPLICANT INFORMATION:
Business Name: Fax #
Contact Person: Phone #
Email: Cell #
Billing Address:
Mailing Address:
$2,500.00
$334.26
$2.02
$2.64
$3.16
Deposit for water flow meter assembly
Base fee for water usage per month
Per 100 cf up to 1,000 cf of water used
Per 100 cf for 1,001-2,000 cf of water used
Per 100 cf for >2,000 cf of water used
BILLED ON A MONTHLY BASIS per the yearly fee schedule & utility rate
This permit authorizes water removal from this hydrant location only and may not be used for any other location.
I understand, that the use of this meter and water is subject to the same collection and lien procedures under the
law that regulates the water districts as provided in Sumner Municipal Code
13.24.
I
understand that the City of Sumner is not responsible for water quality after it leaves the City of Sumner hydran
t
and I agree to hold the City of Sumner harmless for any water quality problems that may occur after the hydrant.
I further agree to protect the meter and the service where meter connects against damage and assume financia
l
responsibility for the repairs made by such damage, or theft or loss of meter.
In the event of failure to pay the billing in the time specified above, the below signed agrees to pay all costs of
c
ollection, including reasonable attorney fees and costs. If signing as a corporate official, the below signed agrees to
be personally liable for the billing.
A
uthorized Applicant Signature: Date:
Public Works Engineer Approval: Date:
On-side project personnel:
RECORDS SECTION CHECKLIST
Public Works Dept 1104 Maple St, Sumner, WA 98390 253-299-5710
Fax 253-299
-5539 mindeew@sumnerwa.gov
