Water Availability Request | Northwest Water Systems

Property Owner First name

Property Owner Last name

Email

Phone

Water System Name

Include System ID # if known

Service Address

Billing Address

How would you like to receive the determination of Water Adequacy sent to you?

US Mail

Email

Fax

Documentation of Authorization to issue the connection

Not Applicable

Copy of document recorded to title providing the system with a right to water

Copy of a water connection purchase and sale agreement

Written approval of the water system or governing body

If the water system has no governing body, signed statements from a majority of current owners

Note: A notice to title stating that a water system is approved for or intended to serve a property does not guarantee that the property has a legal right to connect to or receive water from that system.

Please give a brief explanation of your project, please include also if it is a new construction, building permit or an ADU.

Is there anything you think we should know?

How would you like to pay?

Credit | Debit (4% fee)

Electronic Check

Paper Check (Preferred)

Cash (Least preferred)

If we have additional questions, how would you like us to contact you?

I acept the $126.68 fee. I will send in a payment via check payable to Northwest Water Systems, send cash or make the payment over the phone with office staff for an additional 4% fee. I understand that by request I can pay by checking and routing number.

I understand that if I want a refund, I must request this within 24 hours of purchasing and only a maximum of $50 will be refunded due to the time and energy requests take.

I understand the water availability letter will not be released until payment is made due to company policy.

Signature

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Date

Ngày

Tháng

Năm