Forms – Listed Alphabetically

All of the District’s forms can be found below, listed in alphabetical format; simply click on a link to view and download.

Note: these forms are in Adobe® Acrobat® PDF format and may be viewed using the free Adobe® Acrobat® Reader™. Most newer web browsers already contain the Adobe® Acrobat® Reader™ plug-in. However, if you need it, click here to download it for free now.

Address Change Request
(Document size: 133 k )
If you are changing your billing address, please use this form. Please note, this form cannot be used to change the name on your water bill. In order to have someone else receive the bill, you must fill out the “Request to Bill Non Owner” form.

Certificate of Water Availability – see Fire Flow Analysis Request

Claim for Reduction of Water Charges Due to Leak
(Document size: 113 k )
If you have experienced a leak at your property in the main line between the meter and the house, use this form to submit a request to the District for a possible adjustment on your bill.

Cross Connection Control Installation Permit Application
(Document size: 150 k )
This form is required when applying for a permit to do a cross connection control installation.

Direct Debit – Application
(Document size: 109 k )
Allows you to pay your bill automatically through your checking or savings account. There is no fee for this service.

Direct Debit – Cancellation
(Document size: 115 k )
Allows you to cancel your direct debit payments.

Employment Application
(Document size: 623 k )
When applying for a position at North City Water District, please complete an employment application to accompany your resume.

Facilities Use Agreement and Guidelines
(Document size: 478 k)
The North City Water District Board Room is available for use by government and non-profit agencies when not being used for District business. For more information or to reserve, please download the Facilities Use Guidelines and Agreement.  Complete and return the form to the office.

Fixture Unit Count Sheet
(Document size: 733 k )
Accompanies the Certificate of Water Availability Application.

Fire Flow Analysis Request / Certificate of Water Availability
(Document size: 274 kb)
This form is required when applying for a Certificate of Water Availability for your project.

Low Income Applicationx 17-18
(Document size: 123 k )
This is an annual application form for a discount on your water utility bill. To qualify, your total household income from all sources for 2016 must not exceed the “very low income limits” set annually by HUD for the Seattle area. Qualified applicants will see their water bill base rate reduced by $10 every billing period. This program is limited to the first 150 Single Family Residential customers on a first-come, first-serve basis.

Request for Public Records
(Document size: 111 k )
This form is required when making a request for Public Records.  The form can be downloaded and filled in on your computer.  Please save the form to your computer, then print out and sign the completed form and return to North City Water District via mail, fax or e-mail.

Request to Bill Non Owner
(Document size: 143 k )
This form is for homeowners who would like the water bill to be sent to someone who is not listed on the title of the house. This includes both tenants and property managers. Please note, the bill cannot go to both a property manager and a tenant. If this is the first time filling out the form, there is a one-time $25 fee that applies. Payment of this fee is required before the change can be processed. This fee CANNOT be placed on the final bill.