Request for Water Meter Removal (Demolition) Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.1Fill in Form2Review Information Name: Email billing, This form must be completed by the property owner or authorized contractor. Service Address: *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAre there plans to rebuild within 1 year? *YesNoAccount Number: *Applicant Name: *Phone Number: *Email Address: *Mailing Address (for final billing, If any):Address Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeRequested Date of Removal: *Note: Once the meter has been removed, Leavenworth Waterworks will notify the City of Leavenworth.Rebuild Credit Policy A $500.00 Service Disconnection Fee is required for the processing and physical removal of the meter. This fee must be paid before meter removal. One-Year Credit: I understand that if I rebuild a permanent structure at this same address and request a new meter service within one (1) calendar year of the pull date, the $500.00 fee will be applied as a credit toward the new service installation costs. Expiration: I understand that if a rebuild does not occur within one year, the $500.00 fee becomes non-refundable and non-transferable. Authorization I certify that I am the owner or authorized agent of the property listed above and that the building is being demolished. I authorize Leavenworth Waterworks to access the premises to remove the meter and cap the service lines. Review InformationUpdating preview…This is a preview of your submission. It has not been submitted yet! Please take a moment to verify your information. You can also go back to make changes.PreviousSubmit