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<br /> . , �`����' ��- MUKILTEO WATER DISTRICT C
<br /> • SNOHOMISH COUNTY WASHINGTON � �
<br /> ,. .<-_ ;y�6;t;��
<br /> APPLICATION FUR VfIATER C
<br /> �'jd - 3�S
<br /> �pplication No. /�/ No. Q
<br /> Meter Size Number of Units / Account No. DaS' ��1/�o CUO SU
<br /> I hereby apply tor water service and agree to be governed in accordance with the resoiutions, ruies and regu!ations o(the �
<br /> MUKILTEO WATER DISTRICT peRaining to water service, now or hereafter in elfect. The undersigned as owner or �
<br /> representative oi the herein-described premises hereby agrees as follows: �
<br /> (1) That the cusi of any extension of tho water service,renewal,roplacoment or repair to roact. -nd serve ihe properry descnbed shall be oome �
<br /> by mysclf or assigns as owner(s) o(the premises. �
<br /> (2) That all pipos,�vater measuring devixs and othor connocting equipment upstream from�he moter sha'I,after their installaGon,be and hecome
<br /> the proporty af tho MUKILTEO WATER DISTRICT,subjoct to all its mgulations pertaining to watrr service. C
<br /> (3) That aRor installation,if ineter or meter box and appurtencos are buned or damagod,tho ownor,will 6n held responsiblo and charged for samo.
<br /> (4) ThatthoMUKILTEOWATERDISTRICT,itsollicorsandagoNs,shallhavethorightofingrossandogmsstogouponthepramisasandproperry
<br /> desuibed horoin for tho purposo of inspecGon,connecting ar disconnocting thn sorvico ar for such other purposos as tho service may require.
<br /> It is also understaod during tho timo that any of the wator ma;ns may bo out of service 6y reason of any emergency or improvemerns au�horized
<br /> by tha DISTRICT,in any street ar oiher location in which ihey may haw boen laid,tho DISTRICT will not be roquired ta fumish water during
<br /> the progross of such improvemonts to any consumer whase supply may thus be cut ofl,or be liable for any damagos tor ils failure to do so.
<br /> (5) That tho DISTRICT shall havo tho right to chango ihe ratos at any time by Resolution,to temporarily discontinuo tho sorvico to consumers,and
<br /> toinstalllhemomr(s) toregistorthewaterconsumed. ThaDISTRICTshallnothohaldliabiofordamagebywatororothorpuso msultingfrom
<br /> dofectivo plumbing or appliances insG�Iled 6y tho ownor oroccupant an Iho premisos supplied with waler,and tho faIX that agonts ol tho D ISTPICT
<br /> may havo inspoctod Iho plumbing and appliances shall nnt be plaad as a basis for rocovery in caso of damago as aforosaid. If Iho supply of
<br /> wa;er shall fail or be interrupted by reason of acddent,low prassure or oiher cause whatsoawr,tho DISTRICT shntl not be held liablo for damaoes
<br /> nor sh�ll such tailure or interruptian lorany roasona6lo timu bo held to constituta a breach of contract on Iho part ot tho DISTRICT or in any w;,y
<br /> reliovo tho consumor,whethur tenant or ownor, from perlorming tha obliga6on of sueh tenanPs or owner's conVact. Watar shall be usad hy
<br /> applicant only on Iho premises de3cribed ho�ein. A new applicafion shall bo filed should wator ho dosirod lor other premisos alihough located
<br /> on land doscribed herein.
<br /> ih�(6) Tha� tho DISTRICT recommends Installatlon of a pressura reguleting valve. Applicam acknowledges In(ormatlon as to ihe
<br /> ( recommendntlon and assumes tull responslbllity lor Inetalling or Ialling to Instuil a pressure regulating value on ihe water system to
<br /> pro�ect It from high pressure.
<br /> � ��.-'��.(7) The DISTRICT util(zes check valves at the meier to prevent water retuming to tha Dlstdcts malns. The DISTflICT recommends
<br /> � Installatlonolathermolexpanslonlanktoprovontexeassivopressurobulld-upeausedhythewaterhenter. Appllcanlsacknowtedgee
<br /> . , Informallon ns to Ihn recommendallon and assumos lull responslblity for Instaliing or falling to Install a ihermal expanslon tank.
<br /> ScRVICE ADDFESS � V+u �- U�� , y ' LOT NO. �� � ; � BLOCK
<br /> PLAT NAME: i�� ,�J /` i �� y.� �� '�� - �"' - - .
<br /> CITY/STATE/ZIP: �—^' � LEGAL DESCRIPTION: U• '—' u �iST�—;� �,-'`
<br /> u ✓ ,� 1.� .
<br /> OWNER'S NAME: �- � ..
<br /> —Z"TCp/`�G,l�.�i�. ' � � � "v;�� ' .
<br /> OWNER'S ADDRESS: / ' � �
<br /> „} �
<br /> CiTYiSTATElZIP: �T�`. +�� / `� � C��
<br /> Tho premisos nro to bo used as a
<br /> L `—• - INFORMATION LETTEA-GAVE/SENT. �� �
<br /> —�'i�rC / �� � �� . �.._ ,
<br /> CHARGES:
<br /> (7)Scrvico installatlon 8 anneCian chargo 5 ��, �cb%
<br /> (2)Ganural FadliGas connac6on chargo S n�•— , „
<br /> � i .
<br /> (3)Other 5
<br /> Total nmaunt received with a liwlian S _� +-
<br /> PP � �,�—E�,
<br /> IT IS UNDEFSTCOD thalthis ApplicaUon,alihough signed,shall notho binCing upo�tho MUKILTEO WATER DISTRICTunlil approrod by Iho DISTPICT.
<br /> I, the undorsigned,ownor(or represonWuvo)of tho propony dascribod above,do hereby make applipfion tar install�Gon ol a inch
<br /> c:amotcr watar supply sarvico connaction, includog appunanancas,and all noeessary la6or at my axponsos. ,
<br /> Cated th�s duy 9f'� ,19 �
<br /> � � L ! �� �-
<br /> r
<br /> .�APPLICANTS SIGNATURE: , � . C p�D �
<br /> ApplicanPs Namo (pla�so printj: _ � -
<br /> v ,� '
<br /> _.applicanPs Address and Phono Numbor: 6�=r���J' T�l �o��9�ZE^� tc�e o:� AUG 311990
<br /> APPROVED:
<br /> MUKILTEO WATER DISTRICT MUKILTEO WATER DISTRICT
<br /> ����JJJ
<br /> By�. ����,r Date: /� .
<br />
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