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' "n' �w;T�;.r�!C`�11.�, ,�T'^"�+'"'*�P't ^�+7r!TP77R^71�rl4�"•��!".eli�w.mnw�*•-wia'eY:�+^+wfryrll'n"� 9�y <br /> . ,,,,,` ��o w��n a�srn�cr _ �`� <br /> SMOHOA�SH COUNTY WASHINGTON � <br /> APPLICATION FOR WATER <br /> ApplicationNo. ��� �. q�f��� <br /> Meter Size � �� Number of UnNs � Accour�t No. - � -- - <br /> I hereby apply tor water service and agree to be qovemed in acxordance wilh the ►esohrtfo�, nile o the <br /> MUKILTEO WATER DISTRICT peAafninp to water aenk:e, now or herealler in e(tecl. The underslpned aa ormer or <br /> i <br /> representative of the herein-described premises hereby aprees as tollows: � <br /> i (1) That tlie eoat ot�rry exhncian of 1he w�tar wrviu�renawel�npl�oement o►rp�ir b nwh rnd wrw tM popwy ds�aibW sAN be barN <br /> ;. by'myssfl a auipm u owrwr(y of tM pnmiwa. � <br /> � (2) That iH pipn�waer mweurMp dc�fon end dMr oonnktliW puiP��W�4�han IM rn�br shrl,dl�r MY krul.tlm,b�rd b�oomi <br /> tl�e propsrq of dw MUIQLTEO WATER DISTRICT,tubpct b d Ib npul�tlons p�r�Miq b waMr rrvk�• <br /> (3) ThN ahx In�hAatlon�if inee�r or morr box and appur0onwf an brid ad�mp�d,tFw ow�iw�wM b�Mld napom!ble rid clwy�d M wns. <br /> � (4) TfNt tlw MUItlLTEO WATER DISTRICT,lu olfia�n nd p�nb,�hd Irw IM�ipMd Mprw ad�a b yo upon tlr pnmiass end WopMty <br /> � dnaibW herein br Ihe purpow of inspaclbn�wMrctYq or dhoonn�dMO tlr taMa a for aeh o0:ar pirpotn u Ih�urvios m�y nqW�. <br /> It ic da underabod durinp Ih�tlma tlut uy d tlN waMr m�ku m�y b�aut d wniw M n�fan of my wnwp�ncy a impowmenb�ufadsd � <br /> by tl�DISTAICT�M any tCae[a odwr bcoeon in whkh My m�Y IrM bNn I�W.M DISTRICT aril not b�nquhd b IurM�h wabr durhp \. <br /> tlr qopsa of tuah improv�m�nb b ny aonsum�r wAor suppN m�Y tl�w b�u+l olf.a b�I�N k►�^Y dr^pst br ib Mu�b do a. ` <br /> (5) That IM DISTRICT shd Mv�IM rIGM b ehnp�M nMs at arry tim�by R�wwtlon�b MmPaWY d�anYinN tlw wrvin b aanwn�rt,rid � <br /> binahAlhsm�Mr(s) rorpkbrtlww�0ara�RwP�TRICTMdratb�hNdl�bMlordrmPpy rrrirorolMrofuwnaiYrpkom (� <br /> dahaliwPlumbhpaapplianweln�WlWby �o�up�Monthapnmh�awppRodwrNh.w+br.�Itlwhettlwtap�nbofM»DISTAICT = <br /> m�y hew h�pecmd the plumbinp and appA�naa�frN mt b�pN�d u�ba�is la ncowry In ew of d�mp�q�s�d. M tl»rapply d O <br /> w�ee�sh�AtmlaaMJYrrup�dby��sonol�oddSnR�P��aolMraurwlnbwvsr�MDISifUCT�h�Nnatb�hddi�bNlord��n�pa <br /> nor slall such faiwr�r iM�rtuPtlon for�ny n�son�bb wn�h�Mld b mnstlWM a bnali ol oontncton IM p�rtcP M WSTRICT a N�nN MuY <br /> �eY�v�Ihe aonwma.wtwM�er ten�nt a owner�hom pubrmkq tlN d�Yg�tlon of woh O�n�nPs a ownKs canwU. Wner�hdl W wW hy \. <br /> epp6e�nt oNy on premisas dacaibad henin. A nMw�pplkatlon th�ll be flMd d�a+W w+mr b�de�ked far oMr Pn�^�Ns aMqiqh loarod Nq <br /> on Wid d�w�r�in• . � � . .., . -'1 <br /> .w�,D (Ol Th�t tM DISTNICT noomm�nd� Inslap�Uon ot a pru�un npWMhq velw. Applb�nt �da�ewNdpr N(omutlon u b � <br /> neomm�nd�tlon�nd u�wm�s wl�n�pm�Ibilhy fo�In�W IMp or hpinp to ImWI r pr�wn rpuYtlnp ww on th�w�r�y�pm b <br /> probo�II hom hiph prusun. � <br /> pu <br /> w��_f'L(� Th� OISTHICT utlllm eh�elt v�lvu�t IM m�b pnwnt w�Mr �tuminp b 1� Dlahlob mdn. Th� DISTRICT naonm�nd� <br /> in�ult�Uon of�tlNrmal�aqnabn pnk to p►w�nt�xw�dw pnuunbulld�up a�w�d bY�M�wMMr I�Mr.MPWwnu�dcnowlWp.� <br /> � Mtorm�tlon u to th�neomm�Uo��nd�wumw IuM r«penWbllry tor ImWlinp or hWip b imtdl�th�rmd�apuubn 4Mc. <br /> SERVICE AOORESS: �O9a�S'�/G�/� �I�I S LOT NO. ��K �— <br /> PLAT NAME: <br /> CITYSTATE2IP: EiI f/[lµ. W� 9���70`�' LE(i�L DESCP�aTION: �f O'�' 0"f /oZ � <br /> OWNERSNAME: t45 Ot.J�v �J�t�c I ' �R�/Aau.��' . <br /> OWNER5 ADDPESS: .�P�.� �Sa�� ��^�G S� <br /> CITYSTP.TE21P: L��n n w o o d Cd) fF gP�'37 <br /> The pramises are b bgycad u e � - <br /> eO�n/n e i ri �/ — INFOFlMWTION LEITER-GAVEISENT: .� � � <br /> ' CHARGE3: / <br /> ' �Qi�Ls iljl„D� _ i>s��6mierio�a�oo�d,�. ��. s� 1 y/.''�S C a�} r .C 7) . . <br /> QI ` <br /> SrrL/J/�c t ler•"• ,(2) nera aa nes connecuon up�' .3 a:{'l�—---- <br /> �//�A.GC / (3)Other = ��0.�C U �l-v (':�y o+ c rr. .Yi � �; '��� <br /> �� �' /� Total amount received wilh applicatlon S -� s��'7• �:� <br /> IT IS UNDERSTOOD that this Applieafion,although signed,aheA not be bindrp upon tha MUKILTEO WATER DISTRICT unli�ppowd by Ms DISTAICT. <br /> I,the undenipned,owner(or representa6ve)ot the property dewibod abcve�do MrebY���PO����c�a�^d• � �wh <br /> diemeter water supp 'service eonnection,indudrq appur�n�nus,�nd a�l nerwstary i�bar�t my�xp�nse�. <br /> Dated this�deY of S Y P / r ,19�_. c _ <br /> APPUCANTS SIGNATURE: � _� <br /> ApplicanYs Name(please print): �O� ' � �'`, N ps� . <br /> �ApplicanPs Address and Phone Number: l a I � �5.�� ��o« ��"� 8.[}W <br /> APPROVED• L����Mw'�'�� Wµ �iU3� /�y0�".4!Y�s SEP 171yy� <br /> MUKILTEO WA IS ICT - � <br /> � <br /> � <br /> ,_ <br /> ey. � �. .oaoa: ' �� AlU19LTi�►i;1TER plSiplC1' ; <br /> :,: <br />