Fill - Free fillable RESIDENTIAL UTILITY SERVICE APPLICATION City of Tualatin (City of Tualatin) PDF form

RESIDENTIAL

UTILITY SERVICE APPLICATION

City of Tualatin

18880 SW Martinazzi Ave

Phone (503) 691-3056

Fax (503) 692-0147

billing@tualatin.gov

FirstName:LastName:

Haveyouhadanaccountwithuswithinthelast3years?Y/N

MailingAddress:

Street City  State Zip

HomePhone:

E‐mail:

Employer: 

CellPhone:

Drivers License #: __________________________

Employer’sPhone:

ServiceAddress:

StartServiceDate: Thewateriscurrently: ON/OFF

BringinthesignedapplicationandpictureIDone day prior to start date. You may also email the

completed application to: billing@tualatin.gov (Please note we do not work Saturday, Sunday or

Holidays.)

Doyou ownthisproperty:Y/NIfrenting,pleaseprovideowner’scontactinformationbelow:

Owner’sName:

PhoneNumber:

MailingAddress: _______

Tualatin City Ordinance 839-91 requires this application. Inconsiderationofthecitymakingavailableor

providingcityutilitiesorservicessuchaswater,sewer,stormdrainage,androadmaintenance,the

Applicantagreestocomplywithapplicablecitycodesandregulations.

We are pleased you have chosen to make Tualatin your new home and hope you enjoy this fabulous

community.

TheApplicantfurtheragreestonotifythecityinwritingthedatethatApplicantceasestoneedcity

servicesorotherwisevacatesthepremisesserved.

Signature: Date:

APPLICANT:

SERVICEDETAIL:

AGREEMENTTOCOMPLYWITHTERMSOFSERVICE:

Date of Birth:__________________

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RESIDENTIAL UTILITY SERVICE APPLICATION City of Tualatin (City of Tualatin)

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