Water_Meter_Application.pdf

Temporary Water Meter Application - 1 of 2

City of Naples - Utility Permits 295 Riverside Circle | Naples, Florida 34102 Phone: (239) 213-5051 Fax: (239) 213-5010

TEMPORARY WATER METER APPLICATION

I, the undersigned hereby request a water meter to the city to service the following job site:

TYPE OF CONNECTION: FIRE HYDRANT JUMPER METERMETER SIZE:

COMPANY'S NAME:

BILLING ADDRESS:

SERVICE ADDRESS:

CONTACT NAME: PH #:

IN CONSIDERATION OF APPROVAL BY THE CITY OF NAPLES, OF THIS APPLICATION, THE APPLICANT AGREES

TO THE FOLLOWING:

• Water service applied for, is subject to the continuing availability of raw water Supply and Treatment Plant capacity, and subject to all requirements of law.

• The water meter and backflow assembly shall always remain accessible to utilities personnel for inspection, testing, and maintenance.

• The water meter must not be moved or storage without prior approval by the city utility director.

• There is a one time application fee, installation, relocation, and removal fee; and a daily fee (which shall commence after 90 days upon installation of the meter). A deposit will be collected with the application. The deposit will be returned minus all unpaid above-stated charges and any charges due to damage to the meter and backflow assembly.

• The current water rates will apply for the water recorded by the meter plus a 25 percent surcharge.

I, THE LAWFUL REPRESENTATIVE OF THE ABOVE MENTIONED PROPERTY, HAVE READ AND FULLY

UNDERSTAND ALL STATEMENTS MADE ABOVE.

APPLICANT'S SIGNATURE: DATE:

(Note: If submitting this form electronically, please type your name and date on the corresponding lines above. Also, please review the Electronic Submittal disclaimer below.)

ELECTRONIC SUBMITTAL: (NOTE: The button used to submit this form (via email) will appear upon checking the box and agreeing to the terms below. Saving this entire form for electronic submittal requires a minimum of free Adobe Reader version 11 (or greater), or Adobe Acrobat Standard / Pro).

By checking this box, typing your name in the applicant/citizen signature field(s), and submitting this form electronically (via email), you affirm that all information contained within this document was completed truthfully, and to the best of your knowledge and you understand that your electronic signature is considered legally binding the same as signing your physical signature by hand.

UTILITY DEPT. USE ONLY

Application No.

Work Order No.

Application Fee Deposit Receipt No. Meter

Number

Install, Relocate, Removal

Daily Fee

Damage Fee

•Name of project:_____________________________ •Duration of the project:_______________________ •E-mail for Billing:____________________________ •Provide Aerial of the Hydrant / Jumper Meter Location.

Temporary Water Meter Application - 2 of 2

UTILITY DEPT. USE ONLY

WATER METER INSPECTION INSTALLED RETURNED

DATE

READ

Inlet Hydrant Adapter 4 Test Cocks on Backflow Inlet Shut-off Valve Outlet Shut-off Valve Overall Condition Inspected by

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