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� � � � <br /> ..1 <br /> � �./ . MUKILTEO WATER DISTRICT � <br /> SNOHOMISH COUNTY WASHINGTON � <br /> APPLICATION FOR WATER � <br /> �9 �: <br /> Application No. �� N�' ��—��7 Q <br /> Meter Size � Number of Units � Account No. ��C-�j�1SVU ` <br /> I hereby appiy for water service and agree to be governed in accordance with the resotutions, rules and regulations oi the la <br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in eftect. The undersigned as owner or �. <br /> representative oi the herein-described premises hereby agrees as follows: � <br /> (�) That tho cost ot any ex�ension of tho water service,renewal, repiawment or repair to reach and serve tho properry described shall bo bome \ <br /> by myscl(or assigns as owner(s) of tho premises. <br /> (2) Thatallpipes,watermeasunngdovicosandotherconnocungaquipmentupstreamfromthemomrshall,alterthoirinstallauon,beand6erame <br /> the properry ol th�MUKILTEO VlATER DISTFICT, suhjoct to all its regula6ons portaining to water sorvico. j� <br /> (3) That atler installation,il meter or meror box and appurtencas are buriod or damaged,the awner,will be held rasponsible and charged fcr samu' <br /> (4) That;hu MUKILTEO WATER DISTRICT,its officers and agants,shall have tho right of ingross and egross to go upon�he premisos and properry <br /> descnbod herein�for tho purposo of inspection,connocting or dsconnocung tho sarvim or for such other purposes as tha servico may require. <br /> It is also understood during tho tima;hat any ol tho water mains may be out ol service by masoo of any emergenc�or improvements authorized <br /> by the DISTFICT,in any sVeot or o�her location in which they may haw baen laid,tho DISTFICTwiII not bo requirad to lurnish water Curing <br /> tho progross of such imFrovements to any cansumer whose supp�y may thus bo cut oH,or ba liahlo for any damages for its failure 10 do so. <br /> (5) That tho DISiRICT shall have the right to changa Ihe rates at any Iime by ResoNtion,to tamporarily discondnue tho servico to ccnsumers,and <br /> ro install tho meter(s) to regis:er:ho water consumed. Tho DISTRICT shall not 6a held liablo!or damage by water ar ather causo msulting Irom <br /> dofectivo plumbing or appliances installed by the ownor or occ�paat on Iho premises supplied with watar,and tho fact ffiatagents of Iho DISTRICT <br /> may have inspectod tho pWm6ing and appliances shall not be plond as�basis lor recovery in caso ol damago as aforesaidr If the supply of <br /> water shall f�il or he intarrupted by reason ol acddnnt,low pressuro or other causo whatsoever,tho DISTRIGT shalt not be held liable far damages <br /> nor shali such failuro or interruplion for any roasenahlo Ymo 6o heid to constituto a 6roach ol mntract on the part ot iho DISTRICT ar in'any way <br /> / roliavo tho consumer,whether tanant or ownar,tmm pedarming tho ahligatian ol such tonanCs or owner's contract. Water shall he used 6y <br /> � applicant only on tho premises Cesuibod hemin. A new application shall bo�iled should wamr bo desimd for other premisos although Iocated <br /> on Innd dosai6ed herein. � <br /> ,.�T ) That the DISTRICT reeommends Instnllatlon of a prossure reguleting velve. Appllcant acknowledges Informailan as to Ihe <br /> recommendatlon and assumes full responsiblllty lar Installing or lailing to Insmll a pressuro regulatlng value on ihe waier system to <br /> � protect ll trom high pressure. <br /> �vr _�.—(7) The DISTRICT utlllzos check valves at Iho meier to prevenl waler re�urning to Ihe Dlsirfcls malns. The DISTRICT recommends <br /> �-� inslallatlo�olathermalexpanslontankloprevenlezcesslveprnssurebuiid•upcausedbythowalerheater. Appllcanlsocknowledges <br /> Inlarmntlon aa to tho rceommendotlan and assumes full respans161ity lor Installing or talling to Inslall a thermnl expanslan tank. <br /> � SEP.VICE ADDRESS:'7�0�� �/^"' � ' LOT NO. � BLOC�C � <br /> ,y�/� PL1T NAME:� � �y ��/ '�/v� <br /> CITYISTATFJZIP �i �/Y�' ��.�"0� LEGAL DESCRIPTION: �d�� / <br /> O'.VNER'S NAME:� �D�,/ � GO /�� /�I� � S�G / ,/�/1/ .� I <br /> OWNER'S ADDRESS' ��7 Ar/ � �� �ry <br /> CITYlSTATFJ2IP: `� d '�v 3 <br /> ThopS�mises aro to bo used as �,,. ��� p � � / C. <br /> G � �-N�/ C/7y`^�'-L INFORMATION LETTER,GAVElSENT:✓ � � <br /> CHAqGES: � PL'�iD <br /> (1)Servico i�s�allation 8 connection chargo 5 ��Q' U v _ <br /> (2)Gonaral Facilitles connaction chargo S <br /> �o�a• �,> �IAY 2 61993 <br /> �s�omor 5 I ,7 p�(ILTED WAiER DISiRICT <br /> Total amount received wilh appliwGon 5 ---/ S/��' �v <br /> IT IS UNDERSTCOD;h�t this Applla�tion,although signed,shall nol ho binding upan tho MUKILTEO WATER DIS7RICT until approvad by the DISTRICT. <br /> / <br /> L thu undorsignod,awner(or reprosonta6w)ot tho proparty dosenbed abovo,do hemby mako applicaUon lor installation ot a � , -inch <br /> clamoter water pl servico connection,in I in `ppurtonunces.and�I nec sary labar at my oxpansos. <br /> Dated this ��day ol � <br /> APPLICANTS SIGNATURE: x • <br /> � ,fy � ` E L� <br /> Applic�nCs Namo (ploaso print�: . <br /> Q L L ��/�� � L <br /> -_/Apptiwnt's Addross and Phono Uumber: ��� � �� /1_. �y BY�rSJ/�� <br /> APPROVED: ��� �t��� <br /> MUKI WpTER DISTRICT � @ D���f (N�/ xc� <br /> �L%%��r7_��''� Dato: S Wn4 �/ �O��S U <br /> /JN /�Kl�//" .(i.L //J 1 <br />