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<br /> - MUKILTEO WATER DISTRICT
<br /> . _ SNOHOMISH COUNTY WASHINGTON �
<br /> APPLICATION FOR WATER D
<br /> '�\ .33 l�iY�9"�---/,y�� .. . . ; �...�a _ l97
<br /> _ .Application No. 7 No. �
<br /> Meter Size � ��� Number of Unds � Accourrt No. /7.Jn- ��V U 3/!) O
<br /> I hereby apply for wafers�Ni�'�l atgr�A io be govemed in accordance wfth the resolutions, r�les and regulations oi the �
<br /> MUKILTEO WATER DISTRICT peRaining to water service, now or hereatter in ettect. The undersigned as owner or �
<br /> representative of the herein-described premises hereby agrees as follows: �
<br /> (1) That the cost of any e:tension ot the water service,renewal,replacement ar repair to reach and serve ihe property described shall be bome
<br /> by myself or assigns as owner(s) of the premises. `
<br /> (2) Tha[all pipas,water measuring devices and other connecting epuipment upatream hom the meter sha�l,aher fheir installation,be and become �
<br /> ffie property of the MUKILTEO WATER DISTRICT,6ubject m all its repulanons pertaining ro water service.
<br /> (3) That after installation,if ineter or meter box and appurtances are buned or damaged;the otvner,will be hekl responsible end chargad tor same.
<br /> (4) ThattheMUKILTEOWATERDISTRICT,itsofficereandagenis,shallhavetl�erightofingressendepressrogouponthepremisesandproperty
<br /> described herein for Me purpose af inspection,conneeting or disconnecUng the service ar for sueh other purposes as the servica may aequire.
<br /> It is also understood dunng Uie tlme that any of�he wa�r mainc may be out o�service by raeson of any emergency or improvements authorized
<br /> by Ihe DISTWCT,in any street or other IocaGon�in which Ihey may hava 6een laid,Me DISTRICT will not be required to tumish water during
<br /> the progress of such improvements M any cronsumar whose aupply may Ihuc be cut a%,a be Gabie for eny demages for its failure to do so.
<br /> (5) That the DISTRICT shaA haye th�rjg�it fo p��y the rates at any time by Resolution,to tempwarily diseoritlnue the service to csnsumers,and
<br /> toinstallthemeter(s)1o4egi3te ewater�o6nsGmed. TheDISTR�CTsCallrwtbeheldliablefordarnagebywaterorothercauseresul6nghom
<br /> defective plumbing or appliances installed by the owner orocwpanton the premises suppliedwi4�water,and the fact thatagents of[he DISTRICT
<br /> may have inspected ihe plumbirg and�ppliances shall rwt be plead as a basis for recovery in case of damage as aforesaid. If the supply of
<br /> watershallfailorbein�rruptedbyrea �pf,dqc�dent,lowpressmeao�ercausewhatsoever,NeDISTRICTshal�notbeheldliablefordameges
<br /> nor shall such failure or interruption fo�ny ie�s�onable ' 'Id W consGNfea braach of contract on the partof the DISTRICT or in e�y way
<br /> reiieve Me mnsumer,whetheiaenant or owner,hom . ming the obliga6on of such tenanCc or owner's eonuacl. Water shall be used hy
<br /> appiiwnt only on ihe premises descrihed herein. A new applica5on shaN be filed should water be desired for other premises although located
<br /> �/ � �oy land dascribed herein.
<br /> �T y�[MT'[het the DISTWICT rewmmends {nstellatlo� 04 a pressurs regulating vaive. Applicant aeknowledge� fnformrtion es to Ahe
<br /> � recomn'imdetlon end assumes full responslbllity for Inatallinp or failing lo InataH�pnssura reguliting value on the w�ter aystem to
<br /> iNT� � p�y1eat It hom h{gh pressure. /
<br /> Flp7lfe'OISYflICT utllizes check valves at the meter to prevent water rotueniny to tM Dlstrlets malns. The OISTHICT rxommand:
<br /> .� Installalbnofatharmafexpenaiontanktoprevantexcess)wprassurobulld•upnussdbythew�tmhsater. Appliuntsa�lcnowledgas
<br /> ', 1 Information as tp tha QcS�mmendalion and asaumes tull e�sponslbllly tor Installiny or h11lnp to Inrtalt a Uermel ezpaos:ion unk.
<br /> �J � ,,,ppp
<br /> SE VICE ADDRESS: l LOT NO.[�q BLOCK
<br /> PLAT NAME. / �� r �s, �` .�. .
<br /> CITY/STATE2IP: � l LE�eAL DESCRIPTION�-�
<br /> ' OWNER'S NAME: �,�,�, '�,//P� - :� �/ „ ��-9
<br /> OWNER'SADDRESS�i �Lc,7�J N� 'q��Sa •
<br /> CITYISTATE/ZIP: ��. ��y '���}� r •.
<br /> The premises are to b sed as a ��-� ' '�
<br /> ��"l �tf�6�^�" INFORMAFION LETTER�-GAVE/SENT� ��"J/'��
<br /> CyARGES: �/,J PAID
<br /> (t)Senice installation&conneetion charge $ — ��!7 �7 MA� � 11992
<br /> (2)General FaciliAes connee6on charge $ �� .
<br /> �3�o`n�' s '� l K�L7E(1 ���ATER DISTRtCI
<br /> Total amount received wiCy��lic�qG9n S �
<br /> IT IS UNDERSTOOD Mat this Applica6on,alMough signed,shall rwt be bindirrp upon the MUKILTEO WATER DIS�RICT undl appro�ed by the DISTAICT. ,
<br /> I
<br /> I,Ihe undersignad,ownar(or representative)of the properry deseribed above,do M1ereby maFe appliwGo�br ii�etel�4tion ol a � � -inch ,
<br /> diamerer water supply service connecGon,includin appurrenances,end aN necessary IaDw at my expenses. �
<br /> Dated this� day of ,f9�� .
<br /> APPLICANTS SIGNATURE: �
<br /> Applicam's Name (please pnnt): � �
<br /> � ��ApplicanYs Address and Phone Number � '�
<br /> APPROV : ��^"� . q OJ��-- �j`�� ,�7'�
<br /> MUKI ATER DISTRICT
<br /> v;
<br /> B/ Da
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