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<br /> MUKILTEO WATER DISTRICT �
<br /> SNOHOMISH COUNTY WASHINGTON �, ,�
<br /> APPLICATION FOR WATER � '�
<br /> � c, ,� �G�� �C.L. ��!'�J��S �
<br /> Application No. � �:i �'�� No. �
<br /> �'/`T Number o1 Units �'�' ����'� �` Account No. �:� a����nL�� �
<br /> Ivleler Size , �
<br /> I hereby apply 1or water service and agree to be governed in accordance with 1he resolutions, rules and regulations of ihe
<br /> t�1Ul<ILTEO WATER DI:iTRICT pertaining to water service, now or hereatter in etfecl. The undersigned as owner or
<br /> represeMative ot ihe hereimdescribed premises hereby agrees as follows:
<br /> (7) That ihe cost ol any extension of the water sorvice,renewal, replacement or r^pair to raach and servo the pmperry �escribod shall be bome
<br /> 6y myself or assigns as ownor(s) o�thc premises.
<br /> (2) That al��pipes,water measuring devicos and othur connocting oquipmant upstraam Irom the motor shall,altor their installation,be and 6ewmo
<br /> S�e pmperty ol the MUKILTEO VJATEF DISTRICT, subjoct to all its regu�ations pertaining to wator sorvice.
<br /> ,.,) That atmr installation,if inemr or metorboz nndappurtoncos aro huriod or damaged,the ownor,will be held rosponsible and charged for same.
<br /> (a) That tho MUKILTEO WATER DISTRICT,its ol(icers and agonts,shall havo tho right ol ingress and ogross to go upon the premises and property
<br /> descnbod herein for the purposo of inspoclion,connocting or disconnocting tho sorviw or br such olher purposes as the service may require.
<br /> It is also undersrood during tho time that any ol thc waler mains may be out ol service by reason of any omergency or improvements authorized �
<br /> by tho DISTRICT,in any street or othor localion m which thay may have boen laid,tho DISTRICT will nol be required to furnish waler during
<br /> the progross ol such improvomeNs to any consumer whose supply may ihus bu cut ofl,or be liablo lor any damagos for its taiWro to do so.
<br /> (5) Snat Iho DISTRICT shali havo iho right to chango the ratos at any time by Rosolution,to tomporarily discontinue lhe service to consumers,and
<br /> to install the memr(s) to register�he water consumod. Tho DISTRICT shnll not be hold iiablo for damago by wa�er or othe;a�use msulling(rom
<br /> doloctiva plum6ing or appliances installed by tho ownor or occupant on tho premisos suppliod with water,and tho tact that agents of the D ISTRI C i
<br /> may have inspocted tho plumbing and appliances shall not be pload as a basis icr rocovory in easo ol damago as aforesaid. It the supply ot
<br /> water sha�l fail or be inlerrupiud by reason of acddent,low pressuro or othm cause whatsoovor,Iho DISTRICT shall not be held liable�or damaoes
<br /> nor shall such IaiWro or interruption for any roasonablo timo bo held to wnstitulo a breach of mniract on tho part ot tho DISTRIC i or in nny way
<br /> ralicve tho wnsumar,whothor lenant or ownor,irom perlorming iho obiigation al such Ionanl's or owner's contracl. Waler shall be used by
<br /> applicant only cn the premises desaibed herein. A new applicapon shall be lilod should watar bo dosirod tor othe:premises although located �
<br /> . . r on I�nd described heroin.
<br /> ir;; �� � (6) That the DISTRICT recommends Installallon ol a pressure raguleting valve. Applfcent acknowledges Informellon as to the
<br /> recommendntlon and essumes lull responslblllty tor Inslaliing or Inlling to install e pressura reguleting value on Ihe weler system to
<br /> � c f� protecl It irom high pressure.
<br /> iNt �� � _(7) The DISTRICT ulllixas check valves nt Iho meler lo prevent waler relurning fo lhe Dlstriets melns. The DISTRICT reeommends
<br /> % InstellaUanolathermalezpanslontonktoprovenle:cesalvopressurebulld-upcauaedbythawaterhealer. Applicanlsecknowledges
<br /> � In�ormnllon ns to the roaommendnlion and assumes lull responslbflty for Instelling or feliing to Install a Ihermal ozpansion ta�k.
<br /> '�. �=, ��' �`. tr 7
<br /> SL-RVICE ADDR'cSS: '��1� �� -' �-r" iJ� ' ) !-' � LOl NO. �-� BLOCK
<br /> PLATNAMe: - � ��
<br /> CITYISTATElZIP: '—���- �/ �. � .L-V�'L ' ` �' " `. �f LEGAL DESCRIPTION: �-' � ' !�C�J-%�:j'� 1 �,� �
<br /> 01`JNER'S NAIdE: L�� ,':_ �J",(,! ' f,' : . ;. ; . --!I I'� �=F i f i i!(:T .
<br /> OWNER'S ADDRESS: � "�"�� J ����-�
<br /> CIiV/STATE2IP:
<br /> The premises arc to bo used as a 1; �
<br /> IN'rORMATION LET7ER-GAVEfSENT: �� -
<br /> CHARGES:
<br /> (1)Service insWllation S connection charge S
<br /> 12)Gonoral Fadlitios connocoon cbargo 5 — ! G J~
<br /> (3)Othor 5
<br /> Total amount raceived with nppliwtion 5 -' ��'�
<br /> IT IS UNDERSTOOD�hat this Application,although signed,shall not bo binding upon tha MUKILTEO WATEF DISTRICT until approvr.r��by�F�e DISTRICT.
<br /> , J
<br /> I, tlic undersi�nod,owner(or representaliw)ol tho propeny describod abovo,do heroby mako appliption inr instaltation ol a �� +� -inch
<br /> diameter walor supply sorvico eonnettionrincluding�ppu�nances,and all noeessary�abor at my ozponses.
<br /> Dated Ihis r / day of� '� . . � �9 , G' .
<br /> APPLICANT'S SIGNATUFE: �-�� r� � �� `�✓
<br /> =;�E � � ,-,: ;- - �'g1D
<br /> Appli�anCs I.ame (ploase print):_' � —
<br /> Applicanfs Address and Phone Numbec � � 4"�� �',� `(�<<~ �.! � � �~� ,{ l �/J OCj 2
<br /> 1 1996
<br /> APPROVED: J f��UN!!T'� I1'n;�t,' r ��
<br /> MUl:ILTEO WATER DISTRICT
<br /> CJ.. 5..�-ril t
<br /> f�c«. ! t' 3� Dy�,l�y ��� C�C o l' � ��.:7r:;�7
<br /> By,�. ���� Date: �
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