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Get KS 12159 2019-2024

application. SERVICE LINE AND METER SET APPLICATION FORM 12159 (March 2019) Please print and fill out form completely. Clear Form NAME (Requestor-see page 2) * BUILDER YES MAILING ADDRESS EMAIL ADDRESS CITY ZIP CODE DATE NO STAGE OF COMPLETION (Check one) Nothing Done/ Permit Only Garage/Outbuilding Service Reconnect Dirt Work Only Electric/Propane Foundation Complete Conversion (existing) Framing Framed-In Meter Set Only PROPOSED BUILDING COMPLETION DATE WORK PHONE CELL PHONE ( .

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