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Some web browsers do not allow you to submit documents at all, in which case please save file to your computer and then submit and/or e-mail completed document to backflow@bellevuewa.gov.

Some versions of Adobe allow you to complete forms with digital signatures, if this is the case the signature field in the document should work fine. However, if you do not have a version of Adobe that allows for the use of digital signatures you may also add a signature using the “Fill and Sign” feature in adobe if this is available. If none of these options are available please print and manually sign the document to certify all information is correct.

Send in the form immediately and contact Bellevue Utilities Finance Department at 425-452-6989 as soon as possible. The City of Bellevue reserves the right to charge penalty fees for customers who do not submit forms on time. The maximum penalty may be a daily charge of water usage for the maximum volume of the truck. For example, if a truck holds 500 gallons, the charge will be $8.52/ccf based on one 500 gallon fill for each day of the month in which usage was not reported

The City of Bellevue issues yearly permits with the expectation that permit holders utilize water on a consistent basis and are in need. If permit is not being used it is suggested that customer call and terminate the permit to avoid penalty fees. If permit holder has not reported any water usage (even if form was submitted) for 90-days the City of Bellevue reserves the right to terminate the customers permit at this time. Customer will be notified in permit is terminated.

Permit fees are issued on a yearly basis, without pro-rating. At this time we do not provide reduced or pro-rated fees for tank lot permit charges.

To terminate your permit prior to the end date please contact the City of Bellevue Utilities Backflow Program at backflow@bellevuwa.gov or 425-452-4201.