HomeMy WebLinkAboutTENANT AUTHORIZATION FORMTENANT UTILITY SERVICE APPLICATION
To establish a utility account in the city of Port Townsend, the application must be filled out completely. Upon completion,
please sign and return to the city address shown above, or email to : ptutilities@cityofpt.us. A non-refundable $10.00
account set up fee will be charged for an approved application and will be included on the initial bill.
PROPERTY INFORMATION
Service Address: Port Townsend, WA
Service Location: Inside City Limits Outside City Limits
Occupancy Date:
TENANT CONTACT INFORMATION
Name:
Mailing
Address:
Phone 1: Phone 2:
E-mail:
IMPORTANT NOTICE TO TENANT
Application will not be processed if Property Owner/Manager’s mailing address and signature are omitted from this application.
Pursuant to the Port Townsend Municipal Code (PTMC), notice of utility service termination, whether voluntary (requested
by property owner or tenant) or involuntary (by nonpayment of utility charges), shall be provided to both the occupant of the
premises and the Property Owner/Manager.
PROPERTY OWNER / MANAGER CONTACT INFORMATION
Name:
Company:
Mailing
Address:
Phone 1: Phone 2:
E-mail:
OWNER / MANAGER AFFIRMATION & AUTHORIZATION
By my signature below, I am authorizing the City of Port Townsend to BILL MY TENANT for the utilities at the service
address shown above. Per the PTMC, I understand that in the event my tenant fails to pay these charges, I will be
responsible to pay the bill with all penalties and interest due. I further understand that delinquent utility charges have the
potential to become a lien against the property and/or referred to a collection agency.
Property Owner/Manager – Please Print Name Property Owner/Manager – Please Sign Name Date
PROPERTY OWNER / MANAGER: Prior to returning a tenant’s security deposit, you are encouraged to contact the Utility
Billing Department to verify all outstanding utility bills have been paid in full.