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<br /> MUKILTEO WATER DISTRICT
<br /> SNOHOMISH COUNTY WASHINGTON
<br /> APPLICATION FOR WATER
<br /> i�
<br /> Application No. No. -���J�
<br /> Meter Size ='� �� �� Number of Units _S � Account No. G��O�c�GS /� �S
<br /> I hereby appiy for water service and agree to be governed in accordance with ihe resolutions, rules and regulations oi ihe
<br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in elfect. The undersigned as owner or
<br /> representative of the herein-described premises hereby agrees as follows:
<br /> (1) That�ha cost of any oxtension ol tho waler service,renewal,replacement or repair to reach and serve the properry descri6ed shall be borne
<br /> by myself or assigns as owner(s) of iho premises.
<br /> (2) That all pipas,water moasuring dovices and othorc.nnoeting equipmant upstream from tha moter shall,attortheirinstailation,he and bewme
<br /> the proporry of the MUKILTEO WATER DISTRICT, subjoct to all its regulations perlaining to water servico.
<br /> (3) Thatalterinstallation,ilme�erormetorboxandappurtencosaroburiedordamaged,theowner,wilibeheldresponsi6�eandchargedlorsa;ne.
<br /> (4) ThatihoMUKILTEOWATERDISTRICT,ilsollicersandagonts,shallhaveiherightolingressandegrosstogouponthopromisesandproperry
<br /> describod hmein'x tho purpose ol inspection,connocling or disconnecting tho service or for such olner purposos as tho sorvice may require.
<br /> It is a�so undorstood during th�timo that any of tho water mains may be oul ol service by reason of any emergency or improvements authorized
<br /> by tha DISTRICT,in any street or nlher location in which they may have beon laid,ihe GISTRICT will not bo required to furnish water during
<br /> tho progress of:�ch iinprovements to nny cansumor whose supply may thus be cut oH,or tw liable for any damagos lor its railura to do so.
<br /> (5) That tho DISTRICT shall havo tlio right to chango tho ratos at any time by Reselution,to tomporarily discontinua the servjca to consumers,and
<br /> roinstallthomoter(s) toregister�howaterconsumod. ThoDISTRICTshallnotboheldliablolordamagabywaterorotherwuserosultingfrom
<br /> dofective plumbing or applianws installed by the ownororocwpant on tho premises suppiiod with water,and tho fact that agents ol tho D ISTRICT
<br /> may have inspncted tho plumbing and appliances shall not be plead as a basis for rocovory in casa of damago as aloresaid. If Iho suppiy of
<br /> waler shall fail or ho interrupled by reason ol accident,low pressuro or other causo whatsoavor,the DISTRICT shall not bo heid liahla lor dama;,es
<br /> nor shall such`3iluro or interruplion for any ruasonablo time 6o hold to constitulo a brcach of cordract on the part of tho DISTRICT or in any way
<br /> relinvo iho cons�mar,whother tonant or ownor, Irom pertorming�he obligation of such tonanPs or owner's contracl. Wator shall be used by
<br /> applicant only o�tho premises described horein. A naw applieation shall bo lilod shou�d water 6e dosired for olher premisos although locatea
<br /> ',� on Iand desu'bed heruin.
<br /> iNr '�� � ,(6) Thet tho DI�TRICT recommends Instnlletlon ol e pressure regululing valve. Applicent acknowledges Information es to the
<br /> recommendntlon and essumes lull responslbllity for Installing or lailing to Install a pressure regulaling value on the wator syslem to
<br /> �, .r ptoiect II lrom hlgh pressure.
<br /> iNr �� ' (7) Tho DISTRICT utillzas check valves a� �ho meler �o prevent weior rnturning to tha Dislrlols malns. The DISTRICT recommenda
<br /> Installollon ol e thermel uxpenslon tonk to p tuvent exceselve prassura hulld•up eauaed by Iha water healer. Appllcanls aeknowiadgea
<br /> � � Informetlon es fo Iho rocommendetlon end assumos full responslbilty lor Inslallinp or Ielling lo Inslell a Ihermal ezpenslon tcnk.
<br /> SERVICE ADDRESS: � ��� .3 �J�� f`, (:.':f cL ' i L� LOT NO. � � BLOCK
<br /> � PLATNAME: J`�� �ii .:-. '�: ' f''.
<br /> CITY/STATE/ZIP: [_.`I��° (�i' I ! �� u_�C 1 I LEGAL DESCRIPTION: {
<br /> OWNER'SNAME: iyc�ilL�\�:.��:�'..�:_'�.<�.L�_:l I,.. 4•i` � `JC_ ��'� I �= ([:i
<br /> �
<br /> OWNER'S ADDRESS: � � �'=� � �J 11`��- jl
<br /> CITY/STATE/ZIP: ;: �'lti-�l. Lt,__i�\ '•-���,t:� ?_.
<br /> ..��.,'i . 1' ' .-_ _,
<br /> Tho promisos am to bo usod as a �'•�'�� ' �_� �f L i r� `.:%C' � =. � ,
<br /> >lhIGC�. i Anricri ri�S/Jf�X'E INFORMATION LETTER•GAVEISENT: �
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<br /> CHARGES: l�tilD
<br /> (1)Servico installation 8 connection chargo 5 ����� r`��-�
<br /> 2 �� �;.��
<br /> (2)Ganoral Facilities connection chargo $ � � 2 � • L��� � -� "�`
<br /> _. �3)othor 5 L4JItILTEU 1';A?E� C«li:.i,l
<br /> Total amouM roceived with oppliwGon s J ! G o • �]C]
<br /> IT IS UNDERSTOOD that Ihis Application,althouph signed,shall not bo binding upon tho MUKILTEO WATER DISTRICTuntil approvod by tho DISTRICT.
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<br /> I,tho undersignod,ownor(or represontativa)ol Iho property doscribod nbovo,do horoby mako applicaGon lor installaGon ol a � -inch
<br /> diamoter wator pqly sorvico connocGon,inoluding a,ppurtonances,and all necossary labor at my oxponsos.
<br /> Dated this :' �/ •��� _ day of _��i'... -�G , cin'�� .
<br /> APPLICANTS SIGNATURE: .�TN•*-� ��-��''�� _
<br /> Applicanl's Namo(ploase print): �"�� �"`�� '�'"� �1"
<br /> �pp!icant's Address and Phono Numbor. ��l C�-.'�F3.-"�"L �� �j�i 1��� � �,�C� •g�Ol �
<br /> APPROVED• �-la-S - '1�-.'�`\� l �
<br /> MUKILT ATER DISTRICT
<br /> By: ��''�r�-- Date: �� /Z O o 7
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