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IP � O <br /> MUKILTEO WATER DISTRICT � <br /> _ SNOHOMISH COUNTY WASNINGTON � � <br /> APPLICATION FOR WATEkt W <br /> ~APPlication No: �j-�'�C�.C'"—" No. '7 3 � q� ! <br /> Meter Size _���� �,��/� Number of Units _.� Account No. �G" � �yy��S � <br /> I hereby apply for w�te��ic���nragree to be governed in accordance w8h the resolutions, rules and regulations of the � <br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in elfect. The undersigned as owner or �y <br /> representative of the herein-described premises hereby agrees as foliows: .� <br /> � (t) That the cost of any extension of ihe water service,renewal,replacement or repair to reach and serve the property described shall be 6ome � <br /> by myself or assigns es ewner(s) of the premises. <br /> (2) That all pipes,water measuring devices and other connecting equipmerrt uDaheam from the meter shall,aker their installation,be and hecome �! <br />. the properry of the MUKILTEO WATER DISTRIGT, su6ject W all itc regulations pertaining to water service. yy� <br /> 7 (3) That after installation,it meter or meter box and appurtences are buried ordamaged,the owner,will be helC responsible and charged tor sama. <br /> (4) ThattheMUKILTEOWATERDISTRICT,itsotticersandapents,shallhavetheriphtofingressendegresstoaouponthepremisesandproperty <br /> ' descnbed herein hr the purposa of inspecGon,eonneding or diseonnecting the service or ta such other purposes as the service may require. <br /> ' It is also understood during the Cme Mat any of ihe water mains may be out of service by reason of any emergency or improvements authorized <br /> � by ihe DISTRICT,in any street or other locatlon in which ihey may have bee�laid,the DISTRICT will not be required to furnish water during <br /> the progress of such improvements to any consumer whose supply may thus be eut oH,or be lia�le for any damages for its failure to do so. <br /> � (5) That Ihe CISTRICT shall have the right to change the rates at any time by Resolution,totemporerily disconGnue the service to consumers,and <br /> ; to install the meter(s) to register Me waterwnsumed. The DISTRICT shall notbe held IiaWe fordamage by wateror other cause resulting hom <br /> defective plumbing or appliances installed by the owner oroccupanton the premises suppliedwith water,and the fact thatagents of the D ISTRICT <br /> -._y, may have inspected�the plumbing and appliances shall not be plead as a basis tor recovary in case of damage as aforesaid. If the supply of <br /> water shall fail or be interrupted by reason of accident,low pressura or other cause whatsoever,the DISTRICT shail notbe held liahle for damaaes <br /> �� nor shall such failure or interruption forany reasonabie ume be held to cons6Nte a breach oF contrecton Ihe part of the DISTRICT or in any way <br /> relieve the consumer,whethar tenant.or owner,trom performing Me obligation ot such tenanTs or owner's eonvact. Water shall be used by <br /> applicant only on the premises desaibed berein. A new applicauon shall be filed should water be dvsired lor other premises aHhough located <br /> o nd described herein. <br /> iNr hat the DISTRICT recommmds Installation of a prassure regulating valva. Applieant acknowledges informeflon as to the <br /> r o mendaUon and assumes full responslbility�or installing or falling to Install a pressure regulattng val�ee on[he water system to <br /> otect i1 trom high pressure. <br /> iN�_Z— ) Tha DISTRICT utilizes chr.k valves at the meter to prevent water rMurning to ibe Distrtets mains. The DISTRICT recommends <br /> .� insWllalionotathermalexpansiontanktopreventexcassivepressurebuiWupcausedbythewaterheater. Applicantseeknowledges <br /> � � information es to the recommendation and assumes(ull responslbiity for IosAallinp or failing to install a ihermal ezpgnsion tank. . <br /> ��i <br /> SERVICE ADDRESS: LOT NO. BIOCK ' � �� <br /> � _ PLAT NAME� ���j(�� � ..�.. � <br /> CITY/STATE/ZIP: � �OL LEGAi DESCRIPiION: �����-T � <br /> OWNER'S NAME: S//�/qLl�A' �;�-r��r.�-�/ __ <br /> OWNER'S ADDRESS:IfVJ�� /�Z� v, ' �. . <br /> CITY/STAT�E/ZIP: �/�w�-s-a^� ��f�•� _ <br /> The premises are to be used as a � _ . � <br /> ��-+"���- — �-'� � � IMFORMATION l.'cTTER-GAVE/SEN7: � <br /> CHARGES: �y��� �� ��V <br /> (1)Service instaliation&wnnection charge $ --- W p C��- C�sC� y�z�,�is <br /> (2)Generel Facilities connecfion charge s xD�, ��ybq��9 <br /> (3)Other $ <br /> Totai amount received with appiieabon $ . <br /> IT 1£UNDERSTCX'U Mat this Appliwlion,�Itk�ough signed,shall�ot be binding upon the MUKILTEO WATER DISTRICT until approved by the DISTRICT. <br /> /�� / <br /> I,the undersigned,awner(or representative)of the property described above,do hereby make applicauon for insWllaGon of e a � �nch <br /> diameter water suppl arvice connection,induA'rg appurtenances,and all necessary labor et my�penses. <br /> Dated this _�_ day of <br /> � APPLICANT'S SiGNATURE: � /�I' <br /> ApplicanPs Name (please pnn[): ���/`G ����-�d�� �� �+�7 �0,�, / <br /> _ AppliwnPs Address and Phone Numbec.���a��.� �� ��9� � <br /> APPROV /G 7i� /C/�� 7�'�� vvy�q�O��"� <br /> MUKIL ATER DISTRICT <br /> Sy. Date:�I2lL� � _. <br /> _�/ / ' _ <br /> cii.n <br />