|
1�,� O
<br /> � MUKILTEO WATER DISTRICT �
<br /> SNOHOMISH COUNTY WASHINGTON
<br /> APPLICATION FOR WATER lJ�
<br /> ^ Application No. No. �J —��
<br /> Meter S¢e _/ �/ � �� Number oi Units � Account No. �—�7�/�I330 _ C
<br /> 1 hereby apply tor water service and agree to be governed in accordance with the resolutions, rules and regulations of the �
<br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereafler in effect. The undersigned as owner or --
<br /> representative ot the herein-described premises hereby agrees as lollows: .' j
<br /> (1) That Ne cost of any e�ctension of the water service,renawal,replacement or repair to reach and serve ihe p��perty described shall be borne �
<br /> by myseM or assigns es owner(sJ of the premises. `
<br /> (2) That all pipes,water measuring davices and other connecting equipment upstream Imm the merer shall,aher fheir installation,be and become �
<br /> Me property of the MUKILTEO WATER DISTRICT,subject to all its regulations pertsining ro water service. r
<br /> (3) That after instalWuon,iF merer or meter box and appurtences are buried or damaged,the owner,will be hrld responsible and charged tor same.
<br /> (4) That the MUKILTEO WATER DISTRICT,its officers and agents,sh'alMave the right of ingress and egress w go upon the premises and property � �
<br /> descrihed herein for the purpose of inspection,connecting or disconnectlng the service or for such other purposes as the service may require.
<br /> It is also undersrood dunng Iha time that any of the water mains may be out of eervice by reason of any emergency or improvements authorized �.A
<br /> by the DISTR�CT,in any street or other locafion in which they may have been laid,the DISTRICT will not be requi�ed to furnish water during �
<br /> the p�ogress of such improvements to any consumer wnose supply may thus be cut oN,or be liable for any damages for its faiiure w do so.
<br /> (5) That the DISTRICT shall have the nght to change the retes at any time by Resolution,to temporerily discon4nue the service to consumers,and
<br /> to install ffie meter(s) to register the waterconsumed. The DISTRICT shali not be held 1ia61e(ordamage by water or other cause resulting hom
<br /> defactive plumbing or appliances insWlled by Ma owner oroccupanton the premises supplied with water,and the factthatagents of the D ISTRI CT
<br /> may have inspected the plumbing and appfiances shall nOt be plead as a basis for recovery in case of damage as aforesaid. If the supply of
<br /> water shall fail or 6e interrupted by reason of accident,low pressure orother cause whatsoever,the DISTFICT snaii no[Ls held liable for damages
<br /> nor shall such tailure or interruption for any reasonable ume be held to wnstitute a breach oF contrecton the part of the DISTRICT or in any way
<br /> relieve tlie consumar,whefher tenant or owner,from peAorming the obligaaon oF such tanant's or owner's coniract. Water shalt 6e used by
<br /> applicant only on the premises described herein. A new applicafion shall be filed should wa[er be desired for other premises although located
<br /> on land described herein.
<br /> AiNr 6) That the DISTRICT reeommmds Installation of a pressure regulating valva. Applicant acknowledges i�formation as to the
<br /> recommrndation and assumes full responsibility for{nstalling or fafling lo install e pr�asure regulating value on ihe water syslam lo
<br /> y protect it trom high pressure.
<br /> '(N��(� The DISTRICT utilizes check valves at the meter to prevent water returning to the Districis mains. The DISTRICT recommends
<br /> , installationofathermale:pansiontanktopreventezcesslvepressurabuild•upcausedbytheweterheater.Applicantsacknowiedges
<br /> v! Inlormatior��t�A mmendation and assumes tull responslbiity for Installing or falling to Instail a the+mal expansion tank.
<br /> �
<br /> ,SERVnICE ADDRESS:-.�f�'�/�� /l�����,/t• LOT NO. BLOCK
<br /> JJs.�1.�_.,i �� Jr5 •.��i PLAT NAME:
<br /> GTY/STATE2IP: jis+fT��� ��Oy� LEGAL DESCRIPTION:
<br /> OWNER'S NAME: ��(',g1LaQ,�� G��SF •
<br /> OWNFR'S ADDRESS: ����,��G_ �J�'�r�.
<br /> CITV/STATElZIP: ���l�G�f9`6'��L�=���{ �.37Q�~/' .
<br /> The pr ises are t� .
<br /> �n� "'�� INFOFMATION LETTER-GAVE/SENT:
<br /> �f ��C I
<br /> ���� ✓�/""�Oh� CHARGES:
<br /> (i)Service installa5on 8 wnnection charge $ /��• Q v ��
<br /> (2)General Facili6es connection charge $ u�p
<br /> (3)Other ��� '� 2 51993
<br /> s —
<br /> ,/ Total amount received with applim6on S —�� � l� � v MUKILTEO WqTER DISiRICI
<br /> I i IS UNDERSTOOD that this Application,altl�ough signed,shall not kMe binding upon the MUKILTEO WATER DISTRICT until approved by the DISTRICL ,
<br /> �I, the undersigned,ownar(or representativrij of the proparty dascribe�d above,do he2by make appliwtion ior installafion of a /� �� -inch .
<br /> diac.eter water supply service connectior,including appurtenances.and all necessary labw at my expenses. � (
<br /> �
<br /> Dated this��/ day o� '7���,�/__.� 79 ��i
<br /> --���„�'� � .�� '
<br /> APPLICANT'S SIGNATURE: ��.� �`,\�(iS^
<br /> ApplicanPsMame;pleaseprint): ���� �,C��L-SO . ,i��, �� '�; �
<br /> _ ApplicanPs Address and Phone Number: r�.�-t.(,� ��-�—*��. �k.S�379 ��`�� �
<br /> APPROV . ��27�� .6I�� �l�-1�� rr�/9�U��— � " ,.a��o.�
<br /> MUKI ERDISTRICT ��f�r �r�
<br /> �}
<br /> B . _ Da�: � n`i��\
<br /> W
<br />
|