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<br /> MUKILTEO WATER DISTRICT �
<br /> SNOHOMISH COUNTY WASHINGTON O
<br /> , t ���' -/�G/�, �x
<br /> �1 •- •� _ _ APpLICATIQN FOR WATER ��0��� O
<br /> - Application No. ,f No. �
<br /> Meter Size `"�" Number of Units I Account No. -��.c�-f-�r�✓-F-A-i�- O
<br /> I hereby apply for water service and agree to be governFd in accordance with the resoiutions, rules and regulations oi the p`C
<br /> MUKILTEO WATER DISTRICT pertaining to water service, now or hereafter in, e(fect. The undersigned as.owner or �
<br /> representative of the hereimdescribed premises hereby agrees as follows: C
<br /> (1) That ihe cost of any extension of the water sorvice,ronewal,replacamont or rapair to raach�and serve the proporry described shall bo bome �
<br /> by myself or nssigns os owner(s) of tho premisos.
<br /> - (2) That all pipos,wator moasuring dovicas and other connocting oquipmsnt upstream hom the marer sball,aRor thnir installation,bo and become
<br /> the proporry ot tho MUKILTEO WATER DISTRICT, subject to all its regulafions portaining ro water eorvieo.
<br /> � (3) That after installation,if motoror mator boz end appurtancos ara buriad ordamagod,the ownor,will be held responsiblo an��ehargqd,�or$ame.
<br /> (4) 7hatthoMUKILTEOWATERDISTRICT,itsofficorsandagonta,shalihavetherightolingressandegressrogouponlhopr�misbs�nd'pr6porry �
<br /> doscribad heroin for tho purposo of inspaction,conneding or dseonnaefing the service of tor such other purposes as tho sarvica may require.
<br /> It is also ui �orstood during tho fime thal eny of the water mains may be out ot service by reason of any emergency or improvements authorized
<br /> ' by the DIS i RICT,in any strool or othor!�cari.n in which they may have boon I�id,ihe DISTAICT will not be required to fumish watar during
<br /> � the progross ol such improvamants ro eny consumer Nhose supply mey thus be cut oH,or be liable tor any damages for its Failuro to do so.
<br /> (5) Th�t the DISTRIC7 shoil haw thc right to change tho ralas at any time by Resolution,to temporarily disrnn6nue tho sorvico to consumers,and
<br /> toinstallthomato�(s) torogistarthawatarconsumod. TheDISTFICTshallnotbeholdliabiefordamagebywatararothorcausurosultinghom
<br /> doloctivo plumbing or appliances ins�alled by thn ownaroroccupent on tho premises suppliedwithwatnr,end tho fad thatagents ot the D�STRICT
<br /> may havo inspectod tho plumbing and appl:ances shall not be ploed as a basis for reeovery in case of damago as aforesaid. II tho supply ot
<br /> woter shall lail or be interrupled by roason ol ecddont,low prassure aothercauso whetsoowr,Uie DISTRICTsha�l notbe haid liable tor dameges
<br /> nor shall such failuro or intcrruplion lor any raasonablo timo be hold to constituto a brcaph ot contract on Iho�part of tho DISTRICT or in any way
<br /> roliovu tno consumor,whether tonant or ownor,hom porforming the obligeGon ot sueh tananCs or owner's conVacl. Water shall bo usod 6y
<br /> �wnt only on the premisos desaibad harein. A nnw app:icabon shetl he filod should wator be dosirod tor other promisos alihough Iowted •
<br /> nd dosaibed hcrain.
<br /> i (6 at the DISTftICT recommenda Installetlon o( e preasure reguleting velve Applicant acknowlodges Intormatlon as to the
<br /> r ommendetion and essumes full rcaponslblllty tor Ina�ellfng or falling to Inslall a pressure regulating value on the water system to
<br /> ect It trom high pressure.
<br /> ,.r � (7 e DISTRICT ulilizes chack valver. et lha meter to prevent weter returning to Ihe Districts malns. The DISTRICT recommends
<br /> �� Instelletlonofathermele:penslontenktoprevantexcesslveprossurebulld•upeausedbythew�terheeter. Appllcantsacknowledges
<br /> Inlormetion es to Ihe rncommendatlon end aasumes full respona161ity tor Insmllinp or Ielllnp to Instell e thermal ezpansion tank. �
<br /> SERVICE ADDRESS: I D I� � � )�� I_V Ic�t L,� �I ( .� LOT NO. '� ' r BLcO K _
<br /> S:
<br /> T P.LAT NAME: � -I I S v -
<br /> . CITJ/STATE/ZIP: �I����� ' ��•� '� G � LEGPAL SCRIPTION: . �
<br /> OWNER'S NAME: _
<br /> �' — � C ��G/e$ !
<br /> .,, .
<br /> OWNER'S ADDRESS: /� ' �
<br /> �'� ��' CIIYlSTATE2IP: �(/ • � 7�o�OG ..
<br /> ��,lil(�lP -�'Q,u i �
<br /> 7Jio premisos aro to 6o usnd as a � , ,
<br /> J '
<br /> INFORMATION LETTER-GAVFlSENT:
<br /> , i
<br /> � . � CHARGES: =} , � ��ooU P�D �
<br /> � �
<br /> (t)Service Installation 8 connoction charge 5
<br /> .�• � � �lj� G�U
<br /> ' � (2)General FadliGos connoction chargo 5� `��� `DEC 0 9 1997
<br /> , (3)Olhor � S ar-�p
<br /> 7otai nmoum mceived with appliwoon 5 � ��UKILTEO WAiER DISTRICI
<br /> � y IT IS UNDERSTOOD that this Application,allhough signed,shall not 6e binding upon the MUKILTEO WATEFI DISTRICT until approvod by tha D STRICT.
<br /> 6 �
<br /> �� � I,the undersignod,ownor(or ropresnntativo)of tho propeny describad nbovo,do horoby maka appiiwtion Ior�insWllatinn of a � v -inch �
<br /> ;� � diamotcr wato ���eonnoeti n 'nd 'n ap '� anan es,and al ssary labor at my axpansos. �
<br /> �Dated this d "� �J9'�
<br /> � s
<br /> � �APPLICANTS SIGNATURE:
<br /> 'Appli;anCs Namo (plcase prinQ: � �� � f� ' � � ��� '
<br /> -. ��Applicanfs Address and Phona Numborr,��G �P�� �,���.�- " �'1.'- ��• ��e''`� G
<br /> �. APPROVED: �'�� - 3Ql` '�1�I�
<br /> � MUKILTE TER DISTRICT
<br /> "i. /
<br /> �� gy; �/�. Date: �
<br /> �
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