Hydrant Meter Application - City Of Auburn - 2016 printable pdf download

HYDRANT METER

Form updated

January 2016

APPLICATION

Physical Address:

Mailing Address:

Webpage & Email:

Phone and Fax:

Auburn City Hall Annex, 2

Floor

25 West Main Street

Phone: 253-931-3090

1 East Main Street

Auburn, WA 98001-4998

permitcenter@auburnwa.gov

Fax: 253-804-3114

PROJECT INFORMATION

TYPE OF PERMIT REQUESTED:  Type A (wrench only)

PERMIT NUMBER:

 Type B (Hydrant Meter w/RPBA)

Site Address/Location ____________________________________________________

DATE RECEIVED:

Applicant___________________________________Email:______________________

Company___________________________________ Phone______________________

Billing Address__________________________________________________________

Type A: Number of Wrenches Requested ____________

Type B: Intended Use _________________________________________________________________________

Conditions:

Permittee must possess a City of Auburn Training Card to use city hydrants. Contact (253) 931-3048 to obtain Training Card.

Permittee must report water consumption by submitting Water Use Report Form monthly.

Notes:

Pick-up/Return: Central Stores Maintenance and Operations is located at 1305 C St SW Auburn, WA 98001/(253) 931-3067.

Deposit Refund: The Finance Department will prepare and mail out invoices on a monthly basis. Return of any applicable deposit will be

mailed to the billing address provided within sixty (60) days of Finance Department receipt of total/final charges paid.

(FOR STAFF USE ONLY)

 Type A Wrench

QTY_________ Total Amount Due $_______________________

 Type B Hydrant Meter w/ RPBA Assembly

Total Amount Due $_______________________

Type B Permit Intended Use Accepted by Public Works Utility: YES NO

HYDRANT #___________

QTR SECTION_________

Approved By_____________________________Date_____________________

CENTRAL STORES: Type B Permit Checkout and Return of Hydrant Meter w/ RPBA Assembly

Hydrant Meter w/ RPBA Checkout: DATE_______________ TIME________________

Meter Number_____________________________ Initial Meter Reading__________________________________

DATE_________________ TIME_______________ NOT RETURNED

Hydrant Meter w/ RPBA Return:

Final Meter Reading________________________ Total CCF Consumed__________________________________

Type B Permittees: Hydrant Meter with RPBA Assembly Returned in Acceptable Condition? YES NO

If no, describe damage__________________________________________________________________________

Amount to be billed to Applicant $_________________

I certify that I have read this application and declare under penalty of perjury that the information contained herein is correct and complete. I certify that

anyone utilizing city hydrants under this permit is in possession of a City of Auburn Training Card. I hereby affirm that I will comply with the

conditions listed above.

PRINT NAME:_______________________________SIGNATURE:________________________________DATE:_______________

Hydrant Meter Application - City Of Auburn - 2016

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