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<br /> MUKILTEO WATER DISTRICT �
<br /> SNOHOMtSH COUNTY WASHINGTON
<br /> APPLICATION�FOR WATER �, � /�3 /
<br /> L1 S
<br /> Application No. _�� ��� No. � // �/-�
<br /> Meter Size 7 r- Number of Units __�_ Account NoD�Q�7`1�3��/ �,
<br /> I hereby apply for water service and agree to be governed in accordance with the resolutions, rules and regulations ot the �
<br /> MUKILTFO WATER DISTRICT pertaining to water service, now or hereafter in effect. The undersigned as owner or ,(\
<br /> represer•tative of the herein-described premises hereby agrees as follows: G�
<br /> ;1) That the cost of any extension ot the water service,renewat,replacement or repair to reach and serve the property described shall be borne O
<br /> by myself or assigns a�owner(s) of the premises.
<br /> (2, That all pipes,water measuring davices and other connec[ing equipment upstream from the mater shall,after their installa[ion,be and become
<br /> the properry ot the MUKILTEO WATEF DISTRICT, subject to all i1s regulations pertaining to water service.
<br /> (3) That after installauon,if ineter or meter hox and appurtences are buried or damaged,the owner,will be held responsibie and charged for same.
<br /> (4) That the MUKILTEO WATER DISTRICT,its officers and agents,shall have the right of ingress and egress to go upon the premises and property
<br /> descrihed herein for the purpose ol inspection,conneaing or disconnecting the serviw or for such other pu�poses as the service may require.
<br /> It is also undersrood dming ihe time that any oi the watar mains may be out of service by reason of any emergency or improvements authorized
<br /> by the DISTRICT,in any street or other location in which they may have been laid,the DISTRICT will not be required ro furnish water during
<br /> the progress of such improvemen[s to any consu�er whose supply may thus be cut ofl,or be liable for any damages for its failure to do so.
<br /> (5) That the DISTRICT shall have the right to changB`the"Tates at any time by ResoWtion,ro temporarily discontinue the service ro consumers.and
<br /> to instali the meter(s) to register the waterconsumed. The DISTRICT shall not be held liable for damage by water orother wuse resulting from - .
<br /> defec6ve plumbing or applianws installed by the owner oroccupant on the premises suppliedwith water,and the fact that agents of the�ISTRI CT
<br /> , may have inspected the pWm6ing and appliances shall not be plead as a basis for recovery in case ol damage as aforesa�d. If the supply of
<br /> water shall fail or 6e intermpted by reason of accident,low pressure or otheroause whatsoever,the DISTRICT shall not be held liable for damages
<br /> nor shail such failure orfi[erruption for any reasonable time 6e heid to constitu[e a breach of contract on Ihe part of the DISTRICT or in any way
<br /> relieve ihe wnsumer;whether tenant or owner,irom performing ihe obligabon�ot such tenanCs or owner's coniract Water shall be used by
<br /> epplicant only on Ne premises described herein. A new applicauon shall be tiled should water be desired for other premises although located
<br /> or.land described herein.
<br /> iNT (��That the DISTRICT.recommends installetlon of e pressure regulating valve. Appliwnt aeknowledges in(ormation as to the
<br /> ammendatlon and assumes full responsibility for installing or falling to install a pressure regulating value on the wa1e�system to
<br /> protect it from high pressure.
<br /> ia- _� ) The DISTRICT utilizes check valves ae the merer to Frnvent water returning to ihe Districts mains. The DISTRICT recommends
<br /> , installationofathermalezpansiontanktopreveNexeessivepressurebuild•upeausedbythewalerbeater. Applicantsacknowledg's
<br /> . informalion as iP�� nmendation and assumes full responsi6ilty tor Installing or Ialiing to install a�thermal expansfon lank. -����,'
<br /> 4
<br /> SEFVIC ADDFiESS'� LOT NO. _ BLOCK �
<br /> /� /� PLAT NAME:
<br /> CITY/S'ATE121P: '7 �/ LEGAL DESCRIPTION: � � �
<br /> .: ...fiL • _ -
<br /> OWNER'S NAME: _—_�
<br /> OWNER'S ADDFiESS/y: �� ��� (�
<br /> CITY/STATE/ZIP: /G/��i� iT"��(L�� , _
<br /> The premises�[o be used as a
<br /> �J� INFORMATION LETTER-GAVE/SENT:
<br /> CHAFiGES: /��� ��
<br /> (t)Service instailation&wnneciion charge $
<br /> C t
<br /> (2)General Faciiities connection charge $ �/ L �� //� ��
<br /> � /G3 'G�
<br /> (3)Other $ — ��,',�.e.�t'�'� J
<br /> � Total amount received with applirauon $ � ' � �'�-p_• �� %J'��i���
<br /> /)�Z /ri/�y
<br /> IT:S UNDERSTOOD thatthis Application,although signed,shall not be binding upcn the MUKILTEO WATER DI$TRICT until approved�y the DISTqI�I.
<br /> I,ihe undersigned,owner(or representative)oi Ihe properly described above,do hereby make application forPnstallauon of a � _-inch
<br /> diameter water s ly.service connection,� lu ing appurten ces,anA ali ng{�,e s labw at my expenses."
<br /> . Dated this day of J �� .
<br /> APPLICAN?'S SIGNATURE: � �"� �� Pnii,/
<br /> Applican;'s Name (please print): �
<br /> b � � C MAR 2 8 i9gq
<br /> � App!ican:'s 4ddress and Phone Number.��
<br /> �£,�` YY� 9 ��
<br /> APPROVED� ` "�4 �� �� y� MUKILTEO WATER DISTRILi
<br /> MUKIL T�4 ER DISTRICT
<br /> ��...-�_ 3 �-
<br /> By ___._ Date: ��
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