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
(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 Water Leak Rate Reduction Form 
(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.

COVID-19-Impacted Low Income Water Rate Reduction Program 2020-2021
(Document size: 162 k)
If you are a single family residential customer whose income has been impacted by COVID-19 during the calendar year 2020, you may apply for this reduced water rate program.  To qualify, your anticipated total household income from all sources during 2020 must not exceed the “very low income limits” set annually by HUD for the Seattle / King County area. Qualified applicants will see their residential base rate reduced by 50% every billing period, effective through May 2021. This program is limited to the first 150 single family residential customers on a first-come, first-serve basis.

COVID-19-Impacted Deferred Payment Plan
If your water bill is more than 120 days past due,  North City Water District will be sending out a letter inviting you to enroll in this program, which allows you to pay your past due balance over a period of time, as long as you continue to keep up to date with your current water bill payments. View a sample of this program agreement here >

Cross Connection 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/Certificate of Water Availability Form
(Document size: 274 kb)
This form is required when applying for a Certificate of Water Availability for your project.

Low Income Reduced Water Rate Program 2020-2021
If you are a single family residential customer whose anticipated total household income from all sources for 2019 does not exceed the “very low income limits” set annually by HUD for the Seattle / King County area, you may apply for this program. Qualified applicants will see their residential base rate reduced by 50% every billing period. This program is limited to the first 150 single family low income 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.