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<br /> ;` n��: r:: : ,- SNOH011��1C,�OUNfYWASHIN�iTTON .
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<br /> ' ::�. �i: At ,�:'; s - ;APPLI�A7��A M►!�T,�rR (� /��(y�
<br /> ' ,� � � ;r� ,r'': , � No, +��/O—I—!
<br /> Applkk��tion No '• l a
<br /> .. . � , �
<br /> ,Mete��Siz.S '�; ,, ��- Number of U^.lts � 'lfx,�— A000unt No. ��f��U 1 U
<br /> I tiereby apply for r,ater a� and.a0ree to be pove►ned in a000rdance wlth the reso�utbns,rulea and rep�;latbns ot the
<br /> MUKILTEO WATER DISTRICT pertaininp to water eervioe, now or hereafler in eHect. The undersipned as owner or
<br /> represerrtative of the herekrdescribed premises hereby aprees ar foilows:
<br /> (t) Th�t tM cost of my•i0mdan d tl»waex rtvio�.nrww���Ptnosmnt a np�ir b n�ch ard sww tbs properqr da«ibad tMll br bortr
<br /> by myaaM a�u anw(s) of M pnmiwt.
<br /> (2) Th�t d pipet,walr mwwrYq dwian�nd atlrr oonmaWq pulPm�rN up�hMm kom 1h�m�M tIW�dYr Mk InatNWon�b��nd b�mm�
<br /> M prop�rty of tlr MUIOLTEO WATER DISTR�CT,�ubj�t b d b npl�ons p�rWn4ip eo waYw Mr�la. :
<br /> .. ._,_---(9) Th�tWrimW4Yon.km�Man»Yrboz_and�PY�MnnNbuNdvd�d,tlrawrrr.w�b�MWmpo�rbN�nddrrOblornrtw.
<br /> (!)Th�tMMUIOLTEOWA�ITERD C . �pwiM. p�u
<br /> dualb�d MrNn for Ilr pupa�of imp�aYon�awwMalinO a 6roar�oiq tlr wrvfo�a b►wah oMrr pirpows�s tlr s�ivio�rt�Y�roq k�.
<br /> h b.Mo wdw.aod durino r»Ilm.rwt.ry a n.wq�►mNn.m.y e.ana.wvk.ey rN.on a.ny«ewp�nq«Impowmw,a
<br /> by tM DISTRICT.in rry ahwt a of�w bealiai in whkh�y m�y Irw bNn Wd.t.�DISTRICT wN aot b�oqutid b(umkh w�w duirq
<br /> tlM p10p�p Of nd�knpov�nNnb b riY�w���N40�Y�Y/N+�b�aR Olf.p h�YbM bf�ny drn�pn MI lb Idu�b dD'p.
<br /> (5) Th�t th�DISTAICT dW IrN IM�fpht b chrp�M nM d�ny Wn�by RaoM�.b Mmporrly d�ooniw�IM wrvbs b oonwmrs,Lnd
<br /> b imW rr m�lr p)ro rpMMr IM w�oorounrd. 7M D16TRICT NW not6�IrW hhM brdrmp�by wY►aorir oriw tia+MnY�
<br /> . d�eYwpMmbYpaapp6�na��In�WldbylMowrwraoowqrRonMprrnh�awppMdwM�wiw.u+dlMt�t�hpwiYoNlrD CT
<br /> �uqr h�Inpkbd tlr pMxnWnp and�ppA�nn�htl nol b�pN�d�s a buk lor ncowry in aa o(d�m�p�u NomdU. M tl»wippl�i d
<br /> * . 7nhnMlqNab�YiWrupMbYnuond�oddMKbwpwu�aoMrauwwhabw�r.tlrDIBTAICTdwNnotb�hNdMhNlord�mpn
<br /> nor sIW woh WMn alnqrtuptlon faany nrawbb Im�b�ANd b mirYluM�bn�ch d oontraet m fr putof 1M D18TAICTa In�nY�N
<br /> nY�w M aonwnMr�wMlwr trwit or owiw►�ian V�q M aWp�Yo^of woh IMril's a awwl�oont�t. W�r drl b�wd by
<br /> �r� �ppk�,�nt qiy on rr p�nia dNaiad IwNn A n�w appfo�lkn NW b�flW�hould waur 6�dnired(a otlwr pnn�ta�aMlauph keYW
<br /> on lu�d drarbd IrnM. '
<br /> f� Th�t tM D6TRICT noo�um� N�hll�tlon of � prw�u� np�/�de0 vtlw. App�ant �dmowMdpp Nbnwtlon u to tlj�
<br /> rwomnw�d�tbn�nd�uumu fidl n�pon�q br In�Ylwp w i�Wp b MaW I�pn�wn tpuwtlnp rdw on IM waYr�y�lr�fo
<br /> proqot n nwn nqh yr«.�... ,...
<br /> hl0
<br /> ✓ m n,.asrnicr uwiw an.ac v.w..n m.s�w a pr.�u w.w�.a.n�np w w.a.aws.nu�a n�.o�arn�cr..00nrn.na:
<br /> In�hlWlen W�tlrrwN acWn�bn Wit b pnwnt�mw�lwprrwn MaW�up o�w�d bp rrwMr hwlr.APP������f
<br /> M .r m�na.uon.w...u�...m.w.pon�leuq wr unurMo w arrw a ln.w.uurnw ecn.�.bn u�r. ;
<br /> ..
<br /> , I , - -- _ __�__
<br /> SERVICE ADDR �: ' r tY Y W LpT NO; BLOCK ' �
<br /> - ' J� '�1 S 2.0 y PUT NAME: �'
<br /> • CIN/STATE/DP: '�Ol1l DESCRIPTiON: �, F 't� 2/<_" � :
<br /> � i.
<br /> OWNER'S NAME: ,:�
<br /> OWNERS ADDRE�a• � �� �N i- '�+. Ti/-r /�/1LjL#' t .LLE��� i
<br /> CITY/STATFlLP: ,����oc+r.CS t/�d ,/./'�R! S
<br /> The premiees�re b ba uwd u a , ,
<br /> INFORMI1T10N LE7TER�G�AVEI3ENT:
<br /> �;..,
<br /> CHAROE3:
<br /> . {,)s.rv�ce m:m�emn a 000necdon dnrw s DEC 2 3 t�` � :�
<br /> (z►caanent P.aaoin oonrncuon e�wp� t MUKIIJFA WATER DISTRICT
<br /> . (3)otlwr i
<br /> Tatal�mount realved wi�h�ppYatlon i . . :.
<br /> :.3y.
<br /> IT IS UNDERSTOOD Mrt tldt Appfia8an,dthouph�ipnd,t1uA nol bs bNdrp upon tlie MUKILTEO WATER DISTRICT unli�pprov�d bY 1h�DISTAICT:j.;,
<br /> I�the undenipned�owner(a represeMr6vs)ol tla pioperq dnatb�d Wow,do hw�by m�b�ppYu6on br InaWltlion of■ � �y�• -ind�
<br /> ' diamemr wamr p wrvioe comeetlon�(ucluda0�PWrlrNnas��nd W roatwy I�bor�t my exp�nwt.
<br /> DaOa��his J� �y p� fi�1 ' 1O �7'7 �
<br /> yr, .. .. r , .
<br /> ._ _ __..- -_ _- --
<br /> APPUCANTS`SI6NATURE: . "
<br /> npqicanrs Neme(q�.e PAnt): f '
<br /> APPlieanCe Addreea and Phone Number: / � � '�� �C�GL (�,e.• qBOOS✓
<br /> APPROVED: ' ��3 S6�'��•
<br /> MUKILTE R DISTRICT
<br /> . ,
<br /> By; D�a: g Li
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