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"i`a'b'rJ , . ' � . ..- �+� r/ YJ <br /> AIIUKILTEO WATER DISTRICT <br /> SNOHOMISH COUNTY WASHINGTON rD <br /> APPLICATION FOR WATER <br /> � � � �U� 9�� / ��<<</s.:::r �� -1-J� <br /> _ Application No. ^^��_ ' ;� ., � �. �0� � <br /> f � <br /> Meter Size � �� • [ — Number of Units � Account No. – � � <br /> I hgreby apply tor water serv�ic€an��gr e to be governed in accordance wi;h the resolutions, rules and regulations of the � <br /> MUKILTEO WATER DISTRICT peRaining to water service, now or herearier in effect. The undersigned as owner or v <br /> represer�tative of the herein-described premises hereby agrees as(oliows: � <br /> (1) That the cost of any ex[ension of the wa[er service,renewal,replacement or repair to reach and serve the property descnbed shall be bome � <br /> hy myseN or assigns as owner(s) of the premises. <br /> (2) That all pipas,water measuring devices and other connecCng equipment upstream from the merer shall,aker their installation,be and become <br /> the properry of the MUKILTEO WATEF DISTtiICT,subjeet ro all its repulations pertaining to water service. O <br /> (3) That after installation,if ineter orme'er boz and appurtences are burietl at damaged,the owner,will 6e heW responsibla and charged for same. <br /> (4) That the MUKILTEO WATER DISTRICT,its oHicers andagents,shall have tl�e right of ingress and egress to go upon the premises and property <br /> descri6ed herein for the purpose of inspec6on,connecting or disconreetin9 the service or iw sueh other purposes as the service may require. <br /> It is also urdersrood during ihe tima ihat any of the water mains may be out of servite by reason of any emerganq or improvements authorized <br /> b the DISTRICT,in any street or oMer loca6on in which tliey maY heve been laid,Mie DISTRICT will not be required to fumish water during <br /> th�progress of such improvements to any consumar whose supply mey thus 6e cut oH,or be liable for any demages for iu failure to do so. <br /> (5) That Me DISTPoCT shall have the right ro change Me reles at any time by ResoWtion,to tempaarily discontinue tlie service ro consumers,and <br /> to install the meter(s) to register the water consumed. The DISTR�CT shall notbe hald liable tor damage by waterorother cause resuliing from <br /> defe�tive plumbing or appliances installed by the axner oroccupant on Me premises supplied with water,and th,.faet thatagents of the DISTRICT <br /> may have inspected the plur�6ing and appliances shall not be plead as a basis for recovery in ease of damage as aforesaid. If the supply of <br /> water shall fail or 6e interrupted by reason of acddeni,bw pressure or othercause whatso�ver,the DISTRICT shall notbe held liable fordamages <br /> nor shall such failure or interruption for any reasonable Gme be held m mnstitute a breach of conVact on the part of the DISTRICT or in any way <br /> relieve the consumer,whether tenant o�owner,hom peAorming the obligation of sueh mnanYs or ownul's contraet. Waler shall be used by <br /> applicant only on the premises desui6ed herein. A new appliwtlon shall be filed should water be desired tor other premises although locaied <br /> n land despibed herein. <br /> -ih-�[�'fhat the DISTRICT reeommmds installalion of a pressuro regulating valve. Applieanl aeknowledgea Informatfon as to the <br /> recommmdalion and assumes full responsibllity tor Installing of feiling to Install a prescurs regulating value on the walar system lo <br /> py�ect It irom high pressure. � ' ' <br /> iNr�/f"�df�KcDISTHICT utilizes chack varves et �he meter to prevent water roturning �o the DisUfets mdns. The DISTAICT recommends <br /> --� ins1a11ationofathermelezpanaiontenktopreventaxcessiveprossurebulid-upcau�edbytlrewalerheeter. Applluntsaeknowledgas <br /> ,` 1 Intormation a{�o; e r�ommendetion end assumea full rsaponNblity for Installinp or(alffnp to inalall�Ihxmd expanafon unk. <br /> n � <br /> i <br /> /SERVICE ADDRESS: `O LOT NO. /� �fi�r'� ����u� BLOCK <br /> PLAT NAME: ;///��Cil/ ��OL2�. <br /> CINlSTATE2IP: �J� LEGAL DESCRIPTION: <br /> OWNER'S NAME: ��/� �' `�T� • `�.� /� <br /> OWNER'S ADDRESS: I(� ��J/ /V�/�, A��'�_l// i <br /> GN/STATE/ZIP: ,��T '/l�/{ . �p d.�.�. - <br /> The premises are�to��be used as a � � �,L� <br /> �,� /'�� /-�`�' INFORMATION LETfER-GAVqSENT: �%�-���—� <br /> �� CdARGES: A <br /> (1)Service insWllation 8 wnneaion charge $ —�7� Q� MAR 311992 <br /> � <br /> " (2)General Facilities conrrecUon charge $ . <br /> � MUKILTEO WATER DISiRICT <br /> (3j other 8 <br /> Total amount received with eppliwtion S --L�� U d <br /> IT IS UNDERSTpOD Ma[this Application,altl�ou�h signed,shall not be bin6�g upan the MUKILTEO WATEii DISTRICT un61 approvedby the DISTF89T. <br /> , /� <br /> i,ihe undersigned,owrsr(or repre5enlative)of the property dBscribed e6ove,do heteby meke epplicetbn btmstallelion of e ' -i�ch , <br /> diamater water supply sernce connecUon indudinp ap urtenances,and ail ne�essery labor at my expenses. <br /> Dated this � day of ��� � <br /> APPLICANTS SIGNATURE: � I/ ,/v� C� �— ! CJ'JJ <br /> Applicant's Name(please print): ��K G/ ,rG �yr� Q�� .,��_�,2��!�����6�/"'_'���• <br /> _, ApplicanPs Address and Phone Number �(/ 7�� /y.����----'%!� Y�_--�—�D 1 —�7�' i <br /> APPROVED: �r�y� �. `��0��' ' <br /> MUKILTE W ER DISTRICT <br /> i <br /> BY; � l � 000�: � <br />