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UTILITY SERVICE APPLICATION
To establish a utility account in the city of Port Townsend, this application must be filled out completely. Upon
completion, please sign and return to the 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
ESCROW INFORMATION
*Close of Escrow Date:
*Billing will commence on the date escrow closes as indicated above. It is the property owner’s responsibility
to notify the City of any date changes.
CONTACT INFORMATION
Name:
Mailing
Address:
City: State: Zip:
Phone 1: Phone 2:
E-mail:
AFFIRMATION AND AUTHORIZATION
By my signature below, I acknowledge that I will be responsible to pay the bill with all penalties and interest due.
I further understand that delinquent utility charges can become a lien against the property or referred to a collection
agency.
Property Owner – Please Print Name Property Owner – Please Sign Name Date