Application For Utility Service - City Of Orting printable pdf download

PO Box 489, Orting, WA 98360

Phone: (360) 893-2219 Fax: (360) 893-6809

Application for Utility Service

Owner(s) Name: ____________________________________ Owner Phone #: _______________________

Email Address: _____________________________________

Service Location: ________________________________________

Start Date: _____________________

Mailing Address (different than location): ______________________________________________________

Drivers’ License #______________________________ State license was issued in: ___________________

Name of Employer: ___________________________________ Employers Phone #: ___________________

I hereby make application for utility services from the City of Orting, Washington, subject to all of the provisions

of City Ordinances (OMC 9-1B-7) now existing or hereafter adopted and agrees to pay all charges as provided

for therein and that the obligations of the parties are covered thereby. This application shall automatically grant

the City of Orting the right to access the property for performance of the City’s services. I hereby certify that I

am the legal property owner and have the authority to establish utility services at the above service location.

I understand the City of Orting shall have a lien against the property in accordance with RCW 35.21 and RCW

35.67 of charges which shall be the obligation of the owner of the property, its heirs, successors and assigns,

until the same is paid in full. The City may enforce the lien by shutting off and not restoring water and/or sewer

until all delinquent and unpaid charges are paid in full. The City of Orting may also employ other legal remedies

such as collection agencies, small claims court or an attorney to collect the unpaid amount for the property

owner.

I understand if I put the billing in the name of my tenant and if the tenant fails to pay the utility bill I will be

responsible for all charges including but not limited to utility bill, penalties and any other utility billing fees. A

$150 utility deposit is required before a utility account will be set up in the tenant’s name.

(Utility Deposit: 634.386.00.04.00 – Res #2004-13)

Owners Signature: ____________________________________________

Date: ___________

Please initial if you are allowing the City to establish a utility billing account for your tenant.

(All required information must be provided in order to bill the tenant).

Tenant Name: _________________________________________________ Phone: ____________________

Tenant Mailing Address: ____________________________________________________________________

City ,

State ,

Zip

Tenant Start Date: _____________________ Tenant Signature: ____________________________________

STATE OF WASHINGTON

COUNTY OF ___________

On this day personally appeared before me _____________________, to me known to be the individual(s)

described in and who executed the within and foregoing instrument, and acknowledged that he/she/they signed

the same as his/her/their free and voluntary act and deed, for the uses and purposes therein mentioned.

Given under my hand and seal of office this _______day of _____________, 201__

Notary Public residing at ___________________________ Printed Name____________________________

My Commission Expires: ___________________________

Revised 2/11/16 MPO

Application For Utility Service - City Of Orting