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<br /> � MUKILTEO WATER DISTRICT
<br /> -- SNOfI�MISH COUNTY WASHINGTON
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<br /> ,APPLICATION FOR WATER � —J"::. I j';'`
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<br /> �� .�� _ _ � , �� :. `'Ns oao �(ov
<br /> — Application No. ' ,.� No. U c
<br /> Meler Size ��� � Number of Units ,�� Account No. � � �� �7 �6
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<br /> I hereby apply tor water service'and agree to be governed in acco�dance with the resolutions, rules and regulations oi the
<br /> MUKILTEO WATER DISTRICT�pertaining to water service, now or hereafler in efiect. The undersigned as owner or O
<br /> representalive o!ihe herein-described premises hereby agrees as follows: �
<br /> (i) 7hat the cost of any eztansion ol th`g watar sorvice,renowal,repiacemont or ropair to roach nnd servelhe proporry described shall be bome O
<br /> by mysoll or ussigns os ownor(s)1bf tho promisos. . ': t
<br /> (2) That all pipos,water measunng doJlcos and othor connoctlng equipmant upstream irom ihe moror shall,�(ter their installation,be end become
<br /> Uie proporry ot tho MUKILTEO WATER DISTRICT, subjoct to all its regulations pertaining to water service. �
<br /> (3) That afier insWllation,il moter or mator box ond appurtoncos era buriod or damaged,tho owner,will bo hold responsible and charged tor same. d
<br /> (4) That the MUKILTEO WATER DISTRICT,its olficors and agonts,sha�l have the right of ingress and egress to go upon tho premises and property C
<br /> ..descri6od horoin tor tho purposo ol inspection,connecting or diseonnecfing tho service or for sueh othor purposes as the sorvice may require. �
<br /> It is alsa undcrstood during iho time that any ol tha water meins may be out of service 6y raeson of any omorgency or improvemants authorized �
<br /> by tha DISTRICT,in any sVoo�or other loca6on in which they may have been laid,the DISTRICT will not he requirnd to fumish water durinp
<br /> iha progress ol such improvoments to any consumer whose supply mey thuc be cut oN,or be liable for any damages for its failuro to do so. �
<br /> (5) That tho DISTRICT shall hava the right io chenc�o tho ratos at any.time by Resolution,to tomporarily discontinuo tho service to consumers,and
<br /> toinstaltthomatar(s) torc�istorthowatorconsumed. ThoDIS7RICTshallnotbahbldliablefordamagebywaterorothereauseresulGnglrom �e
<br /> dofoctivo plumbing or appliancas install�d hy tho ownor o�oeapant on tho promises suppliod with wator,and tho fact that agents of tho DISTRI CT
<br /> may havo inspoctad tho plumhing and appliar:oss I �plaad ns a basis lor roa�vory in wse ol dam2go as aforosaid. It the supply af p�
<br /> watershalllailorboiMom�ptedbyreasonolaccident, oWp,�ssuraorothorcausowhatsoewr,theDISTRICTshallnotbeheldliablofordamages �
<br /> nor shall such tailuro or interruption fornny reasonablo Gmo bo lield to constituto a breach ol contract on tt�e part ol the DISTRICT or in any way
<br /> - reliova the mnsumer,whathor tenant or ownor,from podorFning the obligation of sueh tenanCs or owner's eonVaet. Watar ahail be used by O
<br /> applicant only on the promisos desuibud horein. A now epplicaGon shall be filod should water ba dosirod for othor premises although localed '6
<br /> � �Y on land doscribed horoin.
<br /> w; �.� (6) Thel the DISTRICT reeommends Instollallon of e prasaure reguleting valve. Applloent acknowledges Informatlon as to Ihe
<br /> �" recommendatlan and assumes lull responslbitity for Inetelling or falling to install e pressure regulating value on ihe water aystem lo
<br /> protoct It Irom high pressurc.
<br /> INi � (7) The DISTRICT ulilizes chock vel ea et the meter to provent water roturning to�the^Diclrlels melns. The DISTRICT recommends
<br /> � � Irtstel�aUonolathermelexpnnslontenktoprevenlexeesalvapressurebuild•upcaueed�bythewaterheeter. Appllcantsecknowledpes
<br /> ` Informetlon as�o Iha roeommendetion and assumos tull responsl6111y for Inata111nB or�elil�g �o Instell a thermel axpanelon tank.
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<br /> SERVICEADDRESS: �`���� ��^�!"�� ��- l�'��•:� LOTNO. 3 �� ' BLOCK
<br /> PLAT NAME:
<br /> CITV/STATE/ZIP: ��� r LEGAL DESCRIPTION: 1� ?���
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<br /> OWWER'S NAME: i.�� :::2 i�/."'' y-�• a i�;7 � � ;�it' �' ',l��J 'i ;� L.0 ��
<br /> OWNER'S ADDRESS. � - � � �� v�.. .� :i � • 'rl �C. el � :�� :i .-��.� �; ��, .:_ .'
<br /> CITY/STATE/ZIP: � � �„ �✓.�. ( :'✓ ` G ' t�' ?l 7�v: L� �f✓�� ���:�'�� - � , /
<br /> ` .�- x s '. R�
<br /> Tho promisos tuo to bo usod as n �����/ f_�'"`���� ' ' �� `� �-- ,
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<br /> . S�F INFORMATION LETTER•GAVE/SENT: ^""�
<br /> �., CHARGES: F.AID
<br /> (1)Sorvi:e installaGon 8 conneclion chargo S �=��'n� n p q r�
<br /> (2)Goneral Fadlitias eonnaction eharga 5
<br /> �� �:J . ,'�'�1 UtL ' U C��L
<br /> (3)Othor S ,� ,, MUKILTEO WATER DISTRICi
<br /> Total amount recoivod wilh npplicauon S =� ��� ' ���)
<br /> IT IS UNDERSTOOD that this Application,although signed,shall not bo 6indng upon the MUKILTEO WATER DISTRICT unGl approved by the DISTRICT.
<br /> i,Iho undorsignod, ownnr(or roprasonlativo)of tho property doscribed ebovo,do hornby make appliwtion for InstalloGon of a '"�� -inch
<br /> diamoter water supqJy sorvico wnnocGon,i cluding appunanances,end all necessa Iabor at my oxponses.
<br /> Dated Lhis /3 � day of p'� , - e�'%'✓�
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<br /> , APPLICANTS SIGNATUR � '�,''—`--- ��—�- '
<br /> .;.•;; -1`et ��.r����. � n�! n1.l�n De d . �. � .
<br /> Applicanfs Name'(ploaso print): C {� � /
<br /> `- " 'Applicanfs Addross and Phono Numbor: r��4 aO�� �� Jfi �v �-�L-f � � � � l t .I � %� C�� �
<br /> APPROVED:
<br /> MUKIL��ATER DISTRICT /
<br /> ��/i
<br /> By: ;/ l �'� Date: /••//�'/7cUy
<br /> ., � �
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