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2. Project Address:*
3. Billing:*
   -- Select One --Property OwnerContractor
5. Billing Name:*
6. Billing Phone Number*
8. Billing Address:*
10. *NOTE: If the property owner will be responsible for utility bills, they must sign up for an account in the Utility Billing office at 230 W. Hickman Road.
12. Date:*
    Date:
14. First Name*
15. Last Name*
17. Natural Gas Service Application
19. Agreement*

    That in consideration of the City of Waukee running pipeline and furnishing meter and regulator to my residence, I hereby agree with the City of Waukee, Iowa, to connect a major gas-burning fixture or appliance within a period of one hundred twenty (120) days of the date service was installed and made operable upon my premises. I also agree to install interior piping in compliance with the 2015 International Fuel Gas Code. The undersigned does hereby grant and convey unto the City of Waukee, its successors and assigns, a perpetual easement and the right of way to construct operate, inspect, repair, maintain, replace and remove, in whole or in part, pipelines and appurtenances thereto, with ingress to and from the premises, on, over and through the premises constituting the address for which application for gas service is hereby made.

    1. Agree
21. First Name*
22. Last Name*
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

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