Fillable Leak Adjustment Form Web (City of Sumner)

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Leak Adjustment Form Web (City of Sumner)

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File type: PDF

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LEAK ADJUSTMENT FORM
Today’s Date:
Account #: Month(s) Affected:
Owner’s Name: Phone:
Tenant’s Name: Phone:
Service Address:
Where was the leak located?
How was the leak fixed?
PLEASE ATTACH A COPY OF RECEIPT FROM ANY WORK OR MATERIALS USED.
Official Use Only
Sent to Shops: Clerk:
Meter Number:
Leak Fixed? Operator & Date:
Read: Previous Read:
Owner Notified? (How):
Comments:
PLEASE RETURN TO CITY OF SUMNER UTILITIES
1104 Maple Street, Sumner WA 98390 utilities@ci.sumner.wa.us 253-299-5546 Fax 253-299-5509
LEAK ADJUSTMENT FORM
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Leak Adjustment Form Web (City of Sumner)

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Completed 27 July 2020

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